Predictors of survival, functional survival, and hospital readmission in octogenarians after surgical aortic valve replacement.
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 = 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.
['Kuo|Kendra|K|', 'Shah|Pallav|P|', 'Hiebert|Brett|B|', 'Love|Karin|K|', 'Menkis|Alan H|AH|', 'Manji|Rizwan A|RA|', 'Arora|Rakesh C|RC|']
D000369:Aged, 80 and over D001021:Aortic Valve D001024:Aortic Valve Stenosis D002170:Canada D005260:Female D006350:Heart Valve Prosthesis D019918:Heart Valve Prosthesis Implantation D017052:Hospital Mortality D006801:Humans D053208:Kaplan-Meier Estimate D007902:Length of Stay D008297:Male D010359:Patient Readmission D011183:Postoperative Complications D020127:Recovery of Function D012189:Retrospective Studies D012307:Risk Factors D016896:Treatment Outcome
readmission octogenarian cardiac surgery aortic valve surgery long-term survival