• Wouter W Jansen Klomp, Arno P Nierich, Linda M Peelen, George J Brandon Bravo Bruinsma, Dambrink Jan-Henk E JE Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands., Moons Karel G M KGM Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utre, and Van't Hof Arnoud W J AWJ Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands..
• Department of Cardiology, Isala V2.2, Isala Clinics, Dokter van Heesweg 2, 8025AB, Zwolle, The Netherlands. w.w.jansen.klomp@isala.nl.
• J Cardiothorac Surg. 2016 Mar 19; 11: 38.

BackgroundIn patients with symptomatic severe aortic stenosis, advanced age is often a reason for a transcatheter rather than surgical aortic valve replacement. In this pre-transcatheter cohort we had the unique opportunity to study outcomes after surgical aortic valve replacement for severe aortic stenosis in patients who might currently be triaged to a percutaneous approach.MethodsIn a prospective single-center cohort study we compared the incidence of peri-operative complications, mortality, and health-related quality of life in octogenarians versus patients aged <80 years. The quality of life was measured using the SF-36 questionnaire and expressed as a physical and mental component score (PCS and MCS respectively); a score of 50 equals the average score in the age-matched general population. The association between age and the component scores at one-year follow-up was studied with the use of linear regression, corrected for a set of confounding variables.ResultsWe included 762 patients, of whom 21.4 % was aged >80 and 49.0 % underwent concomitant revascularization. In octogenarians, the incidence of post-operative delirium was 11.0 %, which was higher than in patients aged below 80 (6.2 %, p = 0.034); the operative mortality (1.9 % vs. 2.9 %; p = 0.59) and long-term survival were not different however (log-rank p = 0.75). In octogenarians, the quality of life was impaired 30-days after surgery (PCS 45.01, p < 0.001; MCS 48.21, p = 0.04), which improved towards or above normal values at one-year follow-up (PCS: 49.92, p = 0.67, MCS: 52.55, p < 0.001). After correction for confounding, age was not significantly associated with the one-year PCS (β 0.08 per year, p = 0.34) or MCS (β 0.08 per year, p = 0.32).ConclusionsThis pre-transcatheter study showed that surgical aortic valve replacement in octogenarians could be performed with very low mortality, and with a relevant and significant increase of the quality of life towards normal values. Also, age was not associated with a lower PCS or MCS one-year after surgery.

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