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

Abstract

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.

A Cox’s Proportional Model to Assess Survival Prognostic Factors in Patients Over 85 Years of Age Undergoing Heart Surgery

“…Gender does not have a significant impact and at 5 years mortality is not significantly different between males and females, although higher in (8.0% vs. 5.9%, p = 0.332) [11,21]. The lack of differences in early death odds of postoperative hospital death that emerges from our study is in agreement with what was found by Abel and colleagues in octogenarians [8] and by Kurlansky et al [1], on the contrary, contrasts with that found by Kamiya et all [10]. It is difficult to explain why an initial greater survival of the under 85s and therefore less risk then loses significance.…”

“…Likewise with regard to pre-operative cardiogenic shock, it is understandable how the presence of severe cardiac pump impairment -and pre-and post-operative, requiring pharmacological support and with IABP, can influence the outcome and the intrinsic mortality related to cardiogenic shock itself, as well as worsening of chronic renal insufficiency or the onset of acute new renal failure. On the other hand, the literature confirms that in the over 85 yrs there is a persistence/appearance of a severely reduced left ventricular function (OR 8.0, 95% CI 1.2-53.5, p = 0.032) [10].…”

“…Stratifying the data according to the two groups of over and under 85 years of age, it appears that the predictive factors of mortality in the under 85s are: male gender, arterial disease, COPD, aortic valve disease, mitral valve disease, The interaction Unstable angina and the presence of left main occlusion, CCS scale value, RBC transfusions, FFP transfusions, total blood loss, postoperative septic shock, post-operative acute renal failure, stroke, hours of artificial ventilation, VAP, tracheostomy, epiphenomenon of a prolongation of artificial ventilation This was confirmed by the data already present in the literature where it was highlighted that the post-operative course of >85 could be complicated by a prolonged period of artificial ventilation (> 48 hours) in 3.4-12.4% of cases [11,12]; (ii) a higher occurrence of dialysis-dependent acute renal failure (4.9-11.7% vs 5.4%, nons. ); (iii) a more frequent postoperative decline in glomerular filtration rate (<25%): 40% vs. 30%, p = 0.02) [11][12][13], (iii) a higher incidence of brady-severe arrhythmias; (iv) a persistence/occurrence of severely reduced left ventricular function (OR= 8.0, 95%CI= 1.2-53.5, p = 0.032) [10]; (v) a higher incidence of postoperative neurological strokes (ischemic or haemorrhagic strokes, after heart-lung bypass) (1.8-3.6% vs. <1%) [11]. Octogenarians and ultra-octogenarians have a higher likelihood of intraoperative blood transfusion (51% vs. 30%, p < 0.001).…”

“…In octogenarian and ultra-octogenarian patients who, due to post-operative complications, require a prolonged length of stay in ICU, mortality increases considerably and reaches values between: 31-56.5%) Int J GeriatrGerontol, an open access journal ISSN: 2577-0748 [4]. Such advanced age impacts: (i) on hospitalization costs (ii) on early death [OR= 4.28, 95%CI=1.59-11.53] [9] and (OR= 6.7, 95%CI= 1.8-24.4, p = 0.004) [10]; (iiI) on 30-day mortality (3.1-21%, versus 1.6-2.2 p<0.001), although published data are conflicting [7][8][9][10][13][14][15][16][17].…”

Transcatheter aortic valve implantation improves outcome compared to open-heart surgery in kidney transplant recipients requiring aortic valve replacement

“…In contrast, data from a German study showed that mortality after isolated AVR in late octogenarians was underestimated by the EuroSCORE [17]. A similar underestimation of risk may occur with renal transplant patients.…”