Aortic Valve Replacement in Octogenarian Patients: Evaluation, Operative Risk and Mid-Term Outcomes

SUMMARY Background Aortic valve replacement benefits and indications have been clearly established, even for elder populations, with high comorbidity. Even so, the manipulation of aortic atheromas, the use of extracorporeal circulation and aortic clamp, cardiac arrest and the decalcification related to this technique and its possible consequences generate doubts about its indication in this group of patients. Objective To communicate morbidity and mortality of the procedure in octogenarian patients and validate the usefulness of the risk prediction scores most frequently used. Material and Methods A total of 87 octogenarian patients undergoing isolated aortic valve replacement were studied; preoperative, intraoperative and postoperative variables were analyzed and EuroSCORE was applied; to make easier the sub-analysis of logistic EuroSCORE the population was divided into three groups: low, moderate and high risk. Conventional surgical technique was used. For the follow-up, the patient's medical history was analyzed and/or telephone survey was made. Results Mean age was of 83±2.5 years, with a range of 80 to 90 years. About 60% of the population studied was female. Surgical indication was: stenosis 92%, endocarditis 4.6% and valve disease 3.4%. Medical history: hypertension 71%, smoking (nicotinism) 31%, dyslipidemia 39%, diabetes 11.5%, COPD 10%, CKD-dialysis 2.3%, CVA 11.5%, previous AMI 8%, atrial fibrillation 16%, reoperation 15%. Clinical manifestation: asymptomatic 3.45%, chronic stable angina 10.3%, unstable angina 11%, CHF 13.8%, FC III-IV dyspnoea 60%. Moderate to severe left ventricular dysfunction 18.3%. Risk through logistic EuroSCORE 12.4%± 5%. Mean operative time was of 200±61.7 min, extracorporeal circulation 86±32.5 min and aortic clamp 65±18.2 min. Complications: medical bleeding 17.2%, reoperation due to bleeding 5.7%, low cardiac output 13.8%, inotropic agents > 48 hours 32.1%, balloon pump 1.2%, atrial fibrillation 32.2%, temporary peacemaker 20.7%, permanent peacemaker 5.7%, pulmonary complication 3.4%, CVA with sequelaes, oliguric ARF 27.6%, dialysis 5.7%, sternal infection 1.2%, ICU 3±5.2 days of stay 8±9.6, total mortality 10.34%, priority elective mortality 9.5%, non-elective mortality 12.5%. Stay in ICU 3±5.2 days and a total of 8±9.6 days. Divided into groups, the reported mortality was of 7.14%, 15.38% and 5% for low, medium and high risk respectively. The low postoperative cardiac output at 30 days was identified as a mortality predictor (OR 7, p= 0.0011). A number of 71 patients were followed (91%), median 1.203 days (51 to 3.927). Regardless of the preoperative score, survival at the first year was of 98.6%, at three years 87.65%, at 5 years 77.3%, and at 7 years 48.6%. 72% observed an improvement in the quality of life, 21% did not seen changes and 7% of them noted worsening. No predictors in the follow-up were found. Conclusions