Nicolas d’Ostrevy, Hung Ngo Thanh, Céline Lambert, Frédéric Martins-Condé, Gildas Coutu, Bruno Lesourd, Bruno Pereira, Kasra Azarnoush, Lionel Camilleri
Institution : Service de chirurgie cardiovasculaire, CHU Gabriel-Montpied, Clermont-Ferrand
Objectives : The aim of this study was to distinguish among elderly patients those whose postoperative evolution further to surgical aortic valve replacement was unsatisfactory and to seek for geriatric tests predictive of this evolution.
Methods : We prospectively evaluated the incidence, over early and late results, of surgical scores and geriatric profile amid 122 intermediate-risk patients, aged 75 years or more who underwent surgical aortic valve replacement.
Results : In a univariate analysis, the EuroScore II (OR 1.73, 95% CI: 1.21-2.48, P=0.002), STS score (OR 1.39, 95% CI: 1.03-1.88, P=0.03) and a Katz index ≤5 (limitation of at least one daily living activity) (OR 3.35, 95% CI: 1.08-10.35, P=0.03) were predictors of a 30-day unfavorable evolution. In a multivariate analysis, only surgical scores were predictive factors. At 6 months, 20 patients had deceased or had to be readmitted to hospital. At 10 years, survival was 48% [IQR 39-57]. The Katz index ≤5 was the only geriatric test independent of an unfavorable outcome at 6 months (OR 4.51, 95% CI: 1.25-16.29, P=0.02) and of a deleterious effect over long-term survival (OR 3.00, 95% CI: 1.58-5.69, P=0.001).
Conclusion : In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.