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

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

SAVR:

Surgical aortic valve replacement

TAVI:

Transcatheter aortic valve implantation

LVEF:

Left ventricular ejection fraction

NYHA:

New York Heart Association

ADL:

Activities of daily living

IADL:

Instrumental activities of daily living

BMI:

Body Mass Index

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Acknowledgements

All individuals who provide help during the research were listed as authors.

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Authors and Affiliations

  1. Department of Geriatrics, Nantes University Hospital, Boulevard Jacques Monod, 44093, Nantes Cedex 1, France

    Anne Sophie Boureau, Guillaume Chapelet, Marguerite Paille, Gilles Berrut & Laure de Decker

  2. Department of Cardiology and Vascular Diseases, Inserm, UMR 1087, Institut du Thorax, Nantes University Hospital, Nantes, France

    Jean Noel Trochu

  3. Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, Nantes University Hospital, Translink European Network, Nantes, France

    Jean Christian Roussel

Authors
  1. Anne Sophie Boureau
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  2. Guillaume Chapelet
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  3. Marguerite Paille
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  5. Jean Christian Roussel
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  6. Gilles Berrut
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  7. Laure de Decker
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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.

Corresponding author

Correspondence to Anne Sophie Boureau.

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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.

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Boureau, A.S., Chapelet, G., Paille, M. et al. Geriatric factors associated with 1-year mortality after aortic valve replacement. Eur Geriatr Med 9, 845–851 (2018). https://doi.org/10.1007/s41999-018-0118-3

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  • DOI: https://doi.org/10.1007/s41999-018-0118-3

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