• Rev Port Cardiol · Jul 2015

    Comparative Study

    Aortic valve replacement for severe aortic stenosis in octogenarians: patient outcomes and comparison of operative risk scores.

    • António Tralhão, Rui Campante Teles, Manuel Sousa Almeida, Sérgio Madeira, Miguel Borges Santos, Maria João Andrade, Miguel Mendes, and José Pedro Neves.
    • Hospital de Santa Cruz, Western Lisbon Hospital Centre, Department of Cardiology, Carnaxide, Portugal. Electronic address: atralhao@gmail.com.
    • Rev Port Cardiol. 2015 Jul 1; 34 (7-8): 439-46.

    Introduction And AimIsolated aortic valve replacement (AVR) in octogenarians is associated with increased operative risk, due to higher prevalence of associated risk factors and other comorbidities, making outcome prediction essential. We sought to analyze operative mortality and morbidity and to compare the predictive accuracy of the logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) I, EuroSCORE II and Society of Thoracic Surgeons (STS) score in this population.MethodsWe retrospectively enrolled 106 consecutive octogenarians with symptomatic severe aortic stenosis undergoing isolated AVR in a large-volume single center between January 2003 and December 2010 and calculated surgical risk scores.ResultsMean logistic EuroSCORE I, EuroSCORE II and STS score were 14.6±11, 4.4±3.1 and 4.0±2.4%, respectively. Mean operative mortality was 5.7% (six patients). Two (1.9%) patients suffered an ischemic stroke, three (2.8%) required temporary hemodialysis and five (4.7%) had a permanent pacemaker implanted. Five (4.7%) required rethoracotomy. No myocardial infarction or sternal wound infection was observed. Calibration-in-the-large showed overestimation of operative mortality with logistic EuroSCORE I (p=0.036), whereas EuroSCORE II (p=1.0) and STS (p=1.0) showed good calibration. C-statistic values were 0.877 (95% CI 0.800-0.933) for logistic EuroSCORE I, 0.792 (95% CI 0.702-0.864) for EuroSCORE II and 0.702 (95% CI 0.605-0.787) for STS, without statistically significant differences.ConclusionsThese results suggest that AVR can be performed safely in selected octogenarians. EuroSCORE II and STS demonstrated superior calibration and should be the preferred tools for risk assessment, at least for this population.Published by Elsevier España.

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