Geriatric factors associated with 1-year mortality after aortic valve replacement
Surgical aortic valve replacement has been shown to improve survival and quality of life in patients with severe aortic stenosis. However, clinical variables are known to be associated with an increased mortality rate. As geriatric conditions are highly prevalent in this older population, the aim of this study was to identify geriatric factors associated with 1-year mortality after a surgical aortic valve replacement among older patients with severe symptomatic aortic stenosis.
Between January 2012 and September 2014, all patients ≥ 75 years referred for a surgical aortic valve replacement after a complete pre-operative evaluation in a university-affiliated center were included in this observational study. Association between 1-year mortality surgical aortic valve replacement and baseline characteristics including cardiac and geriatric factors was analysed by Cox models.
Mean age of the 197 patients studied was 81.3 ± 3.5 years and 48.2% were men. At 1 year of the intervention, 19 patients (9.6%) were dead. On multivariate analysis, previous cardiac surgery (Hazard ratio [HR] = 10.47, p = 0.03), undergoing concomitant cardiac surgery (HR = 6.22, p = 0.03), pulmonary hypertension (HR = 3.73, 0.04) were still associated with 1-year mortality. Moreover, cognitive impairment was also associated with 1-year mortality (HR = 4.67, p = 0.04).
This study is the first study to show that among geriatric factors, cognitive impairment was a strong predictor of 1-year mortality after a surgical aortic valve replacement in patients aged 75 years old and older, independently of other geriatric and cardiac factors. This study highlights the importance of pre-operative cognitive assessment.
KeywordsGeriatric assessment Aortic valve stenosis Cardiac surgery Survival
Surgical aortic valve replacement
Transcatheter aortic valve implantation
Left ventricular ejection fraction
New York Heart Association
Activities of daily living
Instrumental activities of daily living
Body Mass Index
All individuals who provide help during the research were listed as authors.
ASB has full access to all study data and takes responsibility for the integrity of the data and the accuracy of the data analyses. Study concept and design: ASB and LD. Acquisition of data: MP, ASB and GC. Analysis and interpretation of data: MP, ASB, LD and JCR. Drafting of the manuscript: ASB and LD. Critical revision of the manuscript for important intellectual content: GC, LD, JNT, JCR and GB. Statistical expertise: ASB and LD. Administrative, technical, or material support: LD. Study supervision: LD.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
This study was conducted in accordance with the ethical standards set forth in the declaration of Helsinki. The Committee for the local Ethical Committee of Nantes (France) approved the project and the study is in compliance with the STROBE statement guidelines.
The need for patients consent was waived by the ethics committee.
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