Aortic valve replacement in geriatric patients: Determinants of in-hospital mortality

Background. Aortic valve replacement is a common procedure in elderly patie nts. There has been a great deal of controversy about the risks associated with early mortality. Uncertainty of the risk associated with a small valve continues to remain controversial. This study was designed to identify the risk factors influencing early mortality and establish an accurate model f or the prediction of in-hospital mortality. Methods. One hundred eighty septuagenarians and octogenarians (58% women; m ean age, 76 +/- 4.7 years) underwent primary isolated aortic valve replacem ent between 1986 and 1997, There was an overall mortality of 16.7% (n = 180 ). Patients with a body surface area less than 1.8 m(2) had an in-hospital mortality of 23.2% (n = 95) compared with 8.1% (n = 74; p = 0.009) for pati ents with a body surface area of 1.8 m(2) or more. Patients with a cardiopu lmonary bypass time of less than 100 minutes experienced an early mortality of 8.9% (n = 56) compared with a 10.2% (n = 59) early mortality for patien ts on bypass time between 100 and 124 minutes and a 29.6% (n = 64) early mo rtality in patients with a pump time longer than 124 minutes (p = 0.040). Results. Multivariate logistic regression analysis identified small body su rface area and long cardiopulmonary bypass time as independent risk factors . A higher mortality was seen in female patients and patients receiving sma ller valves. However, there was a strong correlation between small body sur face area, small valve size, and female gender. Conclusions. Small body surface area and long cardiopulmonary bypass time a re two independent risk factors in early mortality for elderly patients und ergoing primary isolated aortic valve replacement. The use of small valves does not influence early mortality. (C) 2001 by The Society of Thoracic Sur geons.