Predictors of survival, functional survival, and hospital readmission in octogenarians after surgical aortic valve replacement

Abstract

Objective: To analyze outcomes and predictors of functional survival (personal care home admission and mortality) and hospital readmission in patients aged 80 years who underwent surgical aortic valve replacement (SAVR) in a Manitoba hospital.Methods: This was a retrospective cohort study of patients aged 80 years who underwent SAVR with or without coronary artery bypass grafting in Manitoba between 1995 and 2014. Data from the Manitoba Adult Cardiac Surgery database and the Manitoba Centre for Health Policy were used. Kaplan-Meier estimates of outcomes and Cox multivariate regression analysis of risk factors were performed. Survival was compared with that of age-and sex-matched life expectancy.Results: A total of 1872 patients were aged 50 years and 378 were aged 80 years, 55% of whom (n ¼ 208) underwent concurrent coronary artery bypass grafting. Compared with younger patients, octogenarians had higher in-hospital mortality (8.5%; P <.001), longer median intensive care unit stay (47.2 hours; P <.001), and longer median in-hospital stay (13 days; P <.001). The median follow-up was 5.2 years. Functional survival was 82.4% at 1 year and 56.5% at 5 years, and freedom from hospital readmission was 61.5% at 1 year and 28.4% at 5 years. Survival approximated the age-and sex-matched life expectancy at 1 year (83.8%) and 5 years (60.8%). Preoperative atrial fibrillation, peripheral vascular disease, female sex, postoperative acute kidney injury, and blood transfusion were associated with adverse outcomes. Conclusions:In eligible octogenarians, SAVR has acceptable 1-and 5-year functional survival and hospital readmission rates, but significant perioperative mortality and morbidity.

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

“…Surgical aortic valve replacement (SAVR) was once the only treatment for severe aortic stenosis, but it was often contraindicated in elderly patients because of their age, the severity of aortic stenosis, and comorbidities [3]. Data from developed countries have shown that about one-third of patients with severe aortic stenosis are unable to undergo surgical thoracotomy because of their high surgical risk, or because of contraindications to surgery and anesthesia [4,5].…”

Outcomes of emergency abdominal surgery in octogenarians: A single-center analysis

“…Recent studies investigated outcomes of patients >80 years of age undergoing cardiovascular or neurosurgical interventions. [10][11][12] However, literature on outcomes of octogenarians undergoing emergency abdominal surgery (EAS) is scarce. 13 Therefore, this study opted to assess the overall and early in-hospital mortality rate, loss of independence, and factors associated with these outcomes in octogenarians undergoing EAS.…”

Association between intraoperative blood product transfusions and acute kidney injury following cardiac surgery

“…Similarly, postoperative blood transfusion has also been associated independently with the increased risk of adverse events and mortality after cardiac surgery. 6 Furthermore, postoperative anemia is common and frequently persists for months after cardiac surgery. When the postoperative hemoglobin level is considered as a continuous variable, every 1 mg/dl decrease in hemoglobin level is associated with a 13% increase in adverse cardiovascular events and a 22% increase in all-cause mortality.…”