High Mortality in Late Octogenarians Undergoing Isolated Aortic Valve Replacement for Aortic Valve Stenosis: EuroSCORE Underestimates Mortality in this Cohort

Hiroyuki Kamiya; Payam Akhyari; Anabel Pedraza; Nadine Tanzeem; Klaus Kallenbach; Artur Lichtenberg; Matthias Karck

doi:10.1055/s-0032-1304544

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2012; 60(05): 343-350
DOI: 10.1055/s-0032-1304544

Original Cardiovascular

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

High Mortality in Late Octogenarians Undergoing Isolated Aortic Valve Replacement for Aortic Valve Stenosis: EuroSCORE Underestimates Mortality in this Cohort

Hiroyuki Kamiya

¹Department of Cardiovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany

,

Payam Akhyari

¹Department of Cardiovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany

,

Anabel Pedraza

²University Hospital Heidelberg, Heidelberg, Germany

,

Nadine Tanzeem

³Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany

,

Klaus Kallenbach

³Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany

,

Artur Lichtenberg

¹Department of Cardiovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany

,

Matthias Karck

³Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany

› Author Affiliations

Abstract

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Abstract

Objectives Considering the expanding technology of catheter-based aortic valve implantation, high-risk patients who would not be suitable for conventional aortic valve replacement (AVR) should be identified.

Methods From 1997 to April 2007, 190 patients aged from 80 and 89 years old received isolated AVR. Patients between 80 and 84 years old were categorized as the early octogenarians (n = 148) and patients between 85 and 89 years old were categorized as the late octogenarians (n = 42).

Results Thirty days mortality in the early and late octogenarians were 6 and 21%, respectively (p = 0.003). The additive and logistic EuroSCORE were 8.0 ± 2.4 and 8.8 ± 1.8 in the early octogenarians and 13.2 ± 11.8 and 14.6 ± 8.7 in the late octogenarians. Multivariate analysis revealed the late octogenarians (OR 6.7, 95%CL 1.8–24.4, p = 0.004) and poor left ventricular function (OR 8.0, 95%CL 1.2–53.5, p = 0.032) as significant risk factors for 30 days mortality. Early octogenarians showed 1-year, 3-year, 5-year, and 8-year survival of 82.4, 67.6, 54.7, and 33%, respectively. Late octogenarians showed 1-year, 3-year, 5-year, and 8-year survivals of 69.0, 66.2, 41.6, 22.3%, respectively.

Conclusions Mortality after AVR in the late octogenarians was very high, and was underestimated by EuroSCORE in this patients group. In late octogenarians, catheter-based aortic valve implantation despite relative low EuroSCORE level could be considered as a reasonable alternative.

Keywords

aortic valve & root - geriatric (includes elderly) - surgery - complications

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References

References
1 Thomas M, Schymik G, Walther T , et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 2010; 122 (1) 62-69
2 Yan TD, Cao C, Martens-Nielsen J , et al. Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review. J Thorac Cardiovasc Surg 2010; 139 (6) 1519-1528
3 Masson JB, Kovac J, Schuler G , et al. Transcatheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv 2009; 2 (9) 811-820
4 Piazza N, Wenaweser P, van Gameren M , et al. Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving system—a Bern-Rotterdam Study. Am Heart J 2010; 159 (2) 323-329
5 Dewey TM, Brown D, Ryan WH, Herbert MA, Prince SL, Mack MJ. Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement. J Thorac Cardiovasc Surg 2008; 135 (1) 180-187
6 Ghazy T, Kappert U, Ouda A, Conen D, Matschke K. A question of clinical reliability: observed versus EuroSCORE-predicted mortality after aortic valve replacement. J Heart Valve Dis 2010; 19 (1) 16-20
7 Schenk S, Fritzsche D, Atoui R, Koertke H, Koerfer R, Eitz T. EuroSCORE-predicted mortality and surgical judgment for interventional aortic valve replacement. J Heart Valve Dis 2010; 19 (1) 5-15
8 Florath I, Albert A, Boening A, Ennker IC, Ennker J. Aortic valve replacement in octogenarians: identification of high-risk patients. Eur J Cardiothorac Surg 2010; 37 (6) 1304-1310
9 Leontyev S, Walther T, Borger MA , et al. Aortic valve replacement in octogenarians: utility of risk stratification with EuroSCORE. Ann Thorac Surg 2009; 87 (5) 1440-1445
10 Thourani VH, Myung R, Kilgo P , et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann Thorac Surg 2008; 86 (5) 1458-1464 , discussion 1464–1465
11 Melby SJ, Zierer A, Kaiser SP , et al. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg 2007; 83 (5) 1651-1656 , discussion 1656–1657
12 Roques F, Nashef SA, Michel P , et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15 (6) 816-822 , discussion 822–823
13 Tzikas A, Piazza N, van Dalen BM , et al. Changes in mitral regurgitation after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2010; 75 (1) 43-49
14 Sharony R, Grossi EA, Saunders PC , et al. Aortic valve replacement in patients with impaired ventricular function. Ann Thorac Surg 2003; 75 (6) 1808-1814
15 Ferrari E, Tozzi P, Hurni M, Ruchat P, Stumpe F, von Segesser LK. Primary isolated aortic valve surgery in octogenarians. Eur J Cardiothorac Surg 2010; 38 (2) 128-133
16 Thourani VH, Myung R, Kilgo P , et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann Thorac Surg 2008; 86 (5) 1458-1464 , discussion 1464–1465