BACKGROUND: Aortic stenosis (AS) is increasingly common in the elderly population. A recent invention of transcatheter aortic valve implantation tends to tilt the risk-benefit balance to favor earlier elective intervention for AS. Hence, decision making for elective intervention in octogenarians gradually becomes important. However, the outcome after elective aortic valve replacement (eAVR) has not been evaluated adequately. This study aimed to identify risk factors after eAVR in octogenarians and investigate their influence on long-term outcome. METHODS AND RESULTS: One hundred and thirty-seven consecutive Japanese octogenarians with AS who underwent eAVR were studied. The mean follow-up period was 35±22 (range, 0-88) months. Long-term overall survival rates after eAVR were 92.0%, 85.2% and 75.5% at 1, 3 and 5 years, respectively. Cox proportional hazards model identified age [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.07-1.43; P<0.01)] and ejection fraction (EF) <50% (HR 3.38; 95%CI 1.34-8.52; P<0.01) as the risk factors of mortality. Post-eAVR survival rates in octogenarians with an EF ≥50% and <50% were 97.3% and 70.4% at 1 year, 90.1% and 65.3% at 3 years, and 84.3% and 39.2% at 5 years, respectively (P<0.0001). CONCLUSIONS: Octogenarians with preserved LV systolic function before surgery have favorable long-term survival after eAVR. However, an EF <50% influences the mortality in octogenarian patients. Therefore, eAVR should be considered for octogenarians with AS before the progression of LV impairment.
BACKGROUND:Aortic stenosis (AS) is increasingly common in the elderly population. A recent invention of transcatheter aortic valve implantation tends to tilt the risk-benefit balance to favor earlier elective intervention for AS. Hence, decision making for elective intervention in octogenarians gradually becomes important. However, the outcome after elective aortic valve replacement (eAVR) has not been evaluated adequately. This study aimed to identify risk factors after eAVR in octogenarians and investigate their influence on long-term outcome. METHODS AND RESULTS: One hundred and thirty-seven consecutive Japanese octogenarians with AS who underwent eAVR were studied. The mean follow-up period was 35±22 (range, 0-88) months. Long-term overall survival rates after eAVR were 92.0%, 85.2% and 75.5% at 1, 3 and 5 years, respectively. Cox proportional hazards model identified age [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.07-1.43; P<0.01)] and ejection fraction (EF) <50% (HR 3.38; 95%CI 1.34-8.52; P<0.01) as the risk factors of mortality. Post-eAVR survival rates in octogenarians with an EF ≥50% and <50% were 97.3% and 70.4% at 1 year, 90.1% and 65.3% at 3 years, and 84.3% and 39.2% at 5 years, respectively (P<0.0001). CONCLUSIONS: Octogenarians with preserved LV systolic function before surgery have favorable long-term survival after eAVR. However, an EF <50% influences the mortality in octogenarian patients. Therefore, eAVR should be considered for octogenarians with AS before the progression of LV impairment.