Is an age of 80 years or greater an important predictor of short-term outcomes of isolated aortic valve replacement in veterans?

Abstract

There is a popular perception that aortic valve replacement (AVR) in octogenarians carries a high risk related primarily to advanced age. Using the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program, we identified patients who underwent AVR between 1991 and 2007. A prediction model was constructed using stepwise logistic regression methodology for outcome comparisons. Compared with younger patients (age < 80 years; n = 6,638), older patients (age > or = 80; n = 504) had a higher prevalence of baseline comorbidities. In a comparison of patients propensity-matched by risk profile (459 from each group), the older group had a higher morbidity rate (21.1% vs 15.5%; p < 0.03) but a similar mortality rate (5.2% vs 3.3%; p = 0.19) compared with the younger group. After risk adjustment, age of 80 years or greater was independently associated with higher AVR-related morbidity but not mortality. Further work is needed to identify ways to reduce operative morbidity in the extremely elderly.