Abstract 4286: Octogenarians’ Quality of Life after Contemporary Surgical Aortic Valve Replacement: In the Context of Ongoing Percutaneous Approaches
Advanced age is one of the major components of elevated operative risk evaluation predicted by all risk scoring algorithms in patients undergoing percutaneous or surgical aortic valve replacement (AVR). In the context of emerging percutaneous AVR trials in high risk patients (mostly by advanced age), we sought to assess the quality of life, functional status, independency for engagement in day to day affairs, and early and long-term survival in the octo and nonagenarian in the current era. Between September 2000 and September 2006, 108 consecutive patients aged 80 –92 years (mean: 83.2 ± 2.8) underwent AVR with (n=59) or without (n=49) bypass surgery. Their quality of life (functional status, living arrangements and their involvement in leisure activities) was assessed by using items from the Barthel index for activities of daily living and Karnofsky performance score. The survivors from hospital followed by telephone (3 times at an interval of about 6 months) and by one person. The mean follow-up was 36.5 months (7–78 months) and 100% complete. Overall 30-day in-hospital mortality rate was 9.2% (n=10) which was significantly lower compared to the predicted mortality (14.2%) by parsonet score (p <0.05). The non-adjusted survival rate was 78.2% and 66.5% at one and 3 years respectively. During the follow-up 26 patients died from non-cardiac causes. Among the 71 survivors from hospital, 44 patients (62.0%) were autonomous, 18 patients (25.4%) were semiautonomous, and 9 patients (12.6%) were dependents. Among the survivors 47 patients (66.2%) living in their own homes, 15 (21.1%) in residences and 9 (12.7%) in the supervised setting. The surviving patients were involved social (n= 68, 95.8%), cognitive (n= 68, 95.87%), physical activity (n=65, 91.5%), and/or volunteer and creative activities (n=13, 18.3%). All survivors were cardiac symptoms free. Surgical aortic valve replacement in the extremely elderly patients has an acceptable early and mid-term outcome in the contemporary era. The quality of life and the functional status are comparable to their age-matched population. The degree of importance of age in the preoperative risk assessment for the choice of AVR approach may need to be revised.