PURPOSE:Studies showed that mean life expectancy in patients with aortic stenosis (AS), not corrected surgically, is about two years after the cardiac symptomatology. Purpose of this study was to assess the effect of aortic valve replacement (AVR) on octogenarians’ early and long-term survival, functional status and independency for engagement in day to day affairs in their life. Also to identify high risk octogenarians who will benefit with less invasive percutaneous AVR.
METHODS:Between September 2000 and September 2006, all octogenarians with symptomatic AS who underwent AVR were studied. Parsonnet Score (PS) was used for pre-operative risk assessment. Patients were divided in two risk groups; low risk (PS <40) and high risk (PS>40). We followed all survivors for their early and long-term survival, functional status, living arrangements and their involvement in leisure activities as a measure of quality of life.
RESULTS:108 patients (47 women and 61 men, mean age 83.2 years, 80–92) with symptomatic AS underwent AVR. The mean PS 31 (11–71). There were 92 (85%) in low and 16 (15%) patients in high risk group. Overall 30-day mortality was 9.2% and for low and high risk group was 8% and 26% respectively. One year survival was 84% and 50% for low and high risk groups respectively. After a mean 36.5 months (7–78) follow-up, there were 71 (66%) survivors (mean age 86 years, 81–98). The long-term survival in low risk and high risk group was 70% and 44% respectively. Most of surviving member were independent for their day today function. Functional class, living arrangements, involvement in leisure activities among the 71 survivors are shown in Table 1.
CONCLUSION:AVR in octogenarian is feasible with acceptable mortality and morbidity. Our data suggest that most of the patients were living and the functional status in this age group seem to be positively influenced AVR. These results indicates that proper selection of higher risk patients may achieve better results with less invasive AVR compare to medical therapy.
CLINICAL IMPLICATIONS:This information is useful for future healthcare planning for octogenarians.
DISCLOSURE:Rakesh Chaturvedi, None.