European Geriatric Medicine

, Volume 9, Issue 6, pp 845–851 | Cite as

Geriatric factors associated with 1-year mortality after aortic valve replacement

  • Anne Sophie BoureauEmail author
  • Guillaume Chapelet
  • Marguerite Paille
  • Jean Noel Trochu
  • Jean Christian Roussel
  • Gilles Berrut
  • Laure de Decker
Research Paper



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.


Geriatric 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.

Author contributions

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.

Ethical standards

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.

Informed consent

The need for patients consent was waived by the ethics committee.


  1. 1.
    Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. Lancet 368(9540):1005–1011CrossRefGoogle Scholar
  2. 2.
    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ et al (2017) 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791CrossRefGoogle Scholar
  3. 3.
    Olsson M, Janfjäll H, Orth-Gomér K, Undén A, Rosenqvist M (1996) Quality of life in octogenarians after valve replacement due to aortic stenosis. A prospective comparison with younger patients. Eur Heart J 17(4):583–589CrossRefGoogle Scholar
  4. 4.
    Vasques F, Messori A, Lucenteforte E, Biancari F (2012) Immediate and late outcome of patients aged 80 years and older undergoing isolated aortic valve replacement: a systematic review and meta-analysis of 48 studies. Am Heart J 163(3):477–485CrossRefGoogle Scholar
  5. 5.
    Brennan JM, Edwards FH, Zhao Y, O’Brien SM, Douglas PS, Peterson ED (2012) Long-term survival after aortic valve replacement among high-risk elderly patients in the United States: insights from the Society of Thoracic Surgeons Adult Cardiac Surgery Database, 1991–2007. Circulation 126(13):1621–1629CrossRefGoogle Scholar
  6. 6.
    Saxena A, Poh CL, Dinh DT, Reid CM, Smith JA, Shardey GC et al (2012) Early and late outcomes after isolated aortic valve replacement in octogenarians: an Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Study. Eur J Cardiothorac Surg 41(1):63–68PubMedGoogle Scholar
  7. 7.
    Kolh P, Kerzmann A, Honore C, Comte L, Limet R (2007) Aortic valve surgery in octogenarians: predictive factors for operative and long-term results. Eur J Cardio-Thorac Surg. 31(4):600–606CrossRefGoogle Scholar
  8. 8.
    George I, Yerebakan H, Kalesan B, Nazif T, Kodali S, Smith CR et al (2014) Age alone should not preclude surgery: contemporary outcomes after aortic valve replacement in nonagenarians. J Thorac Cardiovasc Surg 148(4):1360–1369CrossRefGoogle Scholar
  9. 9.
    Ashikhmina EA, Schaff HV, Dearani JA, Sundt TM, Suri RM, Park SJ et al (2011) Aortic valve replacement in the elderly: determinants of late outcome. Circulation 124(9):1070–1078CrossRefGoogle Scholar
  10. 10.
    de Arenaza DP, Pepper J, Lees B, Rubinstein F, Nugara F, Roughton M et al (2010) Preoperative 6-minute walk test adds prognostic information to Euroscore in patients undergoing aortic valve replacement. Heart Br Card Soc. 96(2):113–117CrossRefGoogle Scholar
  11. 11.
    Afilalo J et al (2010) Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 56(20):1668–1676CrossRefGoogle Scholar
  12. 12.
    Thourani VH, Keeling WB, Kilgo PD, Puskas JD, Lattouf OM, Chen EP et al (2011) The impact of body mass index on morbidity and short- and long-term mortality in cardiac valvular surgery. J Thorac Cardiovasc Surg 142(5):1052–1061CrossRefGoogle Scholar
  13. 13.
    Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343:d6553CrossRefGoogle Scholar
  14. 14.
    Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH et al (1992) Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 41(3):237–248CrossRefGoogle Scholar
  15. 15.
    Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S et al (1999) The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutr Burbank Los Angel Cty Calif. 15(2):116–122CrossRefGoogle Scholar
  16. 16.
    Folstein MF, Folstein SE, McHugh PR (1975) « Mini-mental state ». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefGoogle Scholar
  17. 17.
    Dubois B, Slachevsky A, Litvan I, Pillon B (2000) The FAB: a frontal assessment battery at bedside. Neurology 55(11):1621–1626CrossRefGoogle Scholar
  18. 18.
    Katz S, Ab Ford, Rw Moskowitz, Ba Jackson, Jaffe MW (1963) Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. J Am Med Assoc 185:914–919CrossRefGoogle Scholar
  19. 19.
    Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontol 9(3):179–186CrossRefGoogle Scholar
  20. 20.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al (1982–1983) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17(1):37–49CrossRefGoogle Scholar
  21. 21.
    Podsiadlo D, Richardson S (1991) The timed « Up & Go » : a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148CrossRefGoogle Scholar
  22. 22.
    Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society (2011) Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59(1):148–157CrossRefGoogle Scholar
  23. 23.
    Robinson TN, Wu DS, Pointer LF, Dunn CL, Moss M (2012) Preoperative cognitive dysfunction is related to adverse postoperative outcomes in the elderly. J Am Coll Surg. 215(1):12–17 (discussion 17-8) CrossRefGoogle Scholar
  24. 24.
    Kim S, Han H-S, Jung H, Kim K, Hwang DW, Kang S-B et al (2014) Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg. 149(7):633–640CrossRefGoogle Scholar
  25. 25.
    Lin Y, Chen J, Wang Z (2012) Meta-analysis of factors which influence delirium following cardiac surgery. J Card Surg 27(4):481–492CrossRefGoogle Scholar
  26. 26.
    Koster S, Hensens AG, van der Palen J (2009) The long-term cognitive and functional outcomes of postoperative delirium after cardiac surgery. Ann Thorac Surg 87(5):1469–1474CrossRefGoogle Scholar
  27. 27.
    Connolly A, Gaehl E, Martin H, Morris J, Purandare N (2011) Underdiagnosis of dementia in primary care: variations in the observed prevalence and comparisons to the expected prevalence. Aging Ment Health. 15(8):978–984CrossRefGoogle Scholar
  28. 28.
    Partridge JSL, Harari D, Martin FC, Peacock JL, Bell R, Mohammed A et al (2017) Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg 104(6):679–687CrossRefGoogle Scholar
  29. 29.
    Ho PM, Masoudi FA, Spertus JA, Peterson PN, Shroyer AL, McCarthy M et al (2005) Depression predicts mortality following cardiac valve surgery. Ann Thorac Surg 79(4):1255–1259CrossRefGoogle Scholar
  30. 30.
    Roberts WC, Roberts CC, Vowels TJ, Ko JM, Filardo G, Hamman BL et al (2011) Effect of body mass index on survival in patients having aortic valve replacement for aortic stenosis with or without concomitant coronary artery bypass grafting. Am J Cardiol 108(12):1767–1771CrossRefGoogle Scholar
  31. 31.
    Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR et al (2012) EuroSCORE II. Eur J Cardio-Thorac Surg. 41(4):734–744 (discussion 744-5) CrossRefGoogle Scholar
  32. 32.
    Di Eusanio M et al (2011) Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients. J Thorac Cardiovasc Surg 141(4):940–947CrossRefGoogle Scholar
  33. 33.
    Melby SJ, Moon MR, Lindman BR, Bailey MS, Hill LL, Damiano RJ (2011) Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis. J Thorac Cardiovasc Surg 141(6):1424–1430CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  • Anne Sophie Boureau
    • 1
    Email author
  • Guillaume Chapelet
    • 1
  • Marguerite Paille
    • 1
  • Jean Noel Trochu
    • 2
  • Jean Christian Roussel
    • 3
  • Gilles Berrut
    • 1
  • Laure de Decker
    • 1
  1. 1.Department of GeriatricsNantes University HospitalNantes Cedex 1France
  2. 2.Department of Cardiology and Vascular DiseasesInserm, UMR 1087, Institut du Thorax, Nantes University HospitalNantesFrance
  3. 3.Department of Thoracic and Cardiovascular SurgeryInstitut du Thorax, Nantes University Hospital, Translink European NetworkNantesFrance

Personalised recommendations