Risk profile and outcomes of aortic valve replacement in octogenarians

Table 1 Patient demographics n (%)

	All patients (n = 273)	LES < 15 (n = 193)	LES≥15 (n = 80)	P value
Gender (male)	128 (47)	90 (47)	38 (48)	0.900
Age (mean ± SD, yr)	82.7 ± 2.35	82.4 ± 2.21	83.5 ± 2.53	< 0.001
Surgery
AVR	140 (51)	103 (53)	37 (46)	0.280
AVR with CABG	133 (49)	90 (47)	43 (54)
Previous MI
None	231 (85)	180 (93)	51 (64)	< 0.001
≤ 90 d	26 (10)	6 (3)	20 (25)
> 90 d	16 (6)	7 (4)	9 (11)
Diabetes mellitus	30 (11)	27 (14)	3 (4)	0.014
Renal impairment	11 (4)	4 (2)	7 (9)	0.011
Previous PCI	4 (2)	0	4 (5)	0.002
Pulmonary disease	47 (17)	21 (11)	26 (33)	< 0.001
Prior cardiac surgery	13 (5)	1 (1)	12 (15)	< 0.001
CVA/TIA	42 (15)	28 (15)	14 (18)	0.450
PVD	25 (9)	12 (6)	13 (16)	0.009
CAD
None	135 (50)	100 (52)	35 (44)	0.590
1 vessel disease	46 (17)	33 (17)	13 (16)
2 vessel disease	42 (15)	28 (15)	14 (18)
3 vessel disease	49 (18)	31 (16)	18 (23)
Pathology
AS	239 (88)	170 (88)	69 (86)	0.680
AS with mild AR	34 (12)	23 (12)	11 (14)
Valve
Mechanical	15 (6)	13 (7)	2 (3)	0.160
Biological	258 (95)	180 (93)	78 (98)
Cardiogenic shock	4 (2)	0	4 (5)	0.002
Ejection fraction
< 30%	15 (6)	0	15 (19)	< 0.001
30%-49%	62 (23)	37 (19)	25 (31)
50% and above	196 (72)	156 (81)	40 (50)
EuroSCORE, median (IQR)	9 (8-10)	8 (8-9)	11 (10-12)
LES, median (IQR)	11.1 (8.4-16.6)	9.5 (7.9-11.6)	20.7 (17.4-24.9)

Prior cardiac surgery - details of types of surgery: Low risk group [Logistic EuroSCORE (LES) < 15] - thoracic surgery (n = 1); High risk group (LES ≥ 15) - abdominal aortic aneurysm (AAA) repair (n = 1), coronary artery bypass grafting (CABG) (n = 5), peripheral vascular disease (PVD) surgery (n = 2), carotid endarterectomy (n = 1), other (n = 3). Coronary artery disease (CAD) - one patient with missing data (low risk group). P values are for comparisons between LES < 15 and LES ≥ 15 groups. PCI: Percutaneous coronary intervention; AVR: Aortic valve replacement; MI: Myocardial infarction; CVA: Cerebrovascular accident; TIA: Transient ischemic attack; AS: Aortic stenosis; AR: Atrial regurgitation; IQR: Interquartile range.

Table 2 Perioperative and postoperative outcomes n (%)

	All patients (n = 273)	LES < 15 (n = 193)	LES≥15 (n = 80)	Effect (95% CI)	P value
Stroke	13 (5)	8 (4)	5 (6)	OR 1.54 (0.49-4.86)	0.460
MI	3 (1)	3 (2)	0
Cardiac tamponade	14 (5)	7 (4)	7 (9)	OR 2.55 (0.86.7.52)	0.090
Gastrointestinal bleeding	11 (4)	8 (4)	3 (4)	OR 0.90 (0.23-3.49)	0.880
Infection	22 (8)	15 (8)	7 (9)	OR 1.14 (0.45-2.91)	0.790
Renal impairment	44 (16)	26 (14)	18 (23)	OR 1.86 (0.96-3.64)	0.070
PPM insertion	23 (8)	14 (7)	9 (11)	OR 1.60 (0.66-3.87)	0.290
Mortality
30 d	19 (7)	8 (4)	11 (14)	OR 3.69 (1.42-9.55)	0.007
≤ 90 d	31 (11)	16 (8)	15 (19)	OR 2.55 (1.19-5.46)
> 90 d	22 (8)	10 (5)	12 (15)		0.020
Discharge
Home	153 (56)	118 (61)	35 (44)
Other hospital or Ward	97 (36)	64 (33)	33 (41)
Survival (yr), median (IQR)	6.22 (3.00-10.94)	8.74 (3.54-11.07)	4.19 (1.83-5.94)	HR 2.12 (1.40-3.22 )	< 0.001
1 yr postop (95% CI)	87% (82%-90%)	90% (85%-94%)	79% (68%-86%)
5 yr postop (95% CI)	57% (49%-64%)	64% (54%-72%)	40% (26%-55%)
ICU stay
Median (IQR)	1 (1-3)	1 (1-3)	2 (1-3)	HR 0.86 (0.66-1.14)	0.290
Death pre ICU	6 (2)	2 (1)	4 (5)
HDU stay
Median (IQR)	3 (1-4)	2 (1-4)	4 (2-5)	HR 0.67 (0.50-0.89)	0.006
Death pre HDU	13 (5)	5 (3)	8 (10)
Ward stay
Median (IQR)	6 (4-9)	6 (4-9)	5 (4-8)	HR 1.16 (0.87-1.55)	0.310
Death pre ICU	17 (6)	7 (4)	10 (13)
Overall, median (IQR)	11 (8-15)	11 (8-15)	11 (8-15)	HR 0.89 (0.67-1.17)	0.400

Effect sizes and P values are for comparisons between the Logistic EuroSCORE (LES) < 15 and LES ≥ 15 groups. Missing data: Discharge destination - low risk (n = 1); Pacemaker insertion - low risk (n = 2); high dependency unit (HDU) and ward length of stay - low risk (n = 2). ICU: Intensive care unit; OR: Odds ratio; HR: Hazard ratio; PPM: Permanent pacemaker; IQR: Interquartile range.