Frailty after aortic valve replacement (AVR) in octogenarians

doi:10.1016/j.archger.2008.03.010

Archives of Gerontology and Geriatrics

Volume 48, Issue 3, May–June 2009, Pages 391-396

https://doi.org/10.1016/j.archger.2008.03.010 Get rights and content

Abstract

In order to analyze the quality of life (QoL) or frailty after AVR for octogenarians, we studied 84 patients older than 80 years who underwent aortic valve replacement alone or in combination with coronary artery bypass, between April 1998 and December 2001. Follow-up was performed in May 2002 with a telephonic interview to evaluate the self-rated QoL, health, and three frailty markers: falls, activity of daily living (ADL) and mood disorder. In-hospital mortality was 16.7%. Fourteen deaths occurred during the follow-up: survival estimates were 85.5% at 1 year and 68.6% at 3 years. Forty-one patients (73.2%) were in New York Heart Association (NYHA) classes I–II for dyspnea and 42 patients (75.0%) were free of angina. Fifty-one patients (91.1%) lived in their own homes. Forty-eight (85.7%) had at least one frailty marker: falls (26.8%), loss of autonomy for ADL (27.0%) or suspected depression (20.2%). All frailty markers were associated with self-rated QoL but not with self-rated health. AVR for octogenarians is associated with good outcome but this population is frail and further studies should assess the usefulness of pre- and postoperative geriatric approach.

Introduction

The challenge of cardiac surgery for patients older than 80 years is to achieve a good QoL at mid-term, with relief of symptoms, persistent autonomy without sequel related to postoperative morbidities that are frequent (Culliford et al., 1991, Alexander et al., 2000, Sundt et al., 2000, Avery et al., 2001, Kolh et al., 2001). QoL and autonomy are perhaps more important results at this age than increased life expectancy after such surgery. Many studies have evaluated the mid- and long-term prognosis after AVR in very old patients (Culliford et al., 1991, Akins et al., 1997, Sundt et al., 2000, Kolh et al., 2001) but little is known about QoL (Olsson et al., 1996, Kirsch et al., 1998, Fruitman et al., 1999, Sjogren and Thulin, 2004, Huber et al., 2007), and none, at our knowledge, has specifically studied geriatric questions after cardiac surgery in this population. It seems crucial to know the prevalence of frailty indicator like loss of autonomy, falls and mood disorder because frailty may alter the benefit of this intervention. The aim of this study was to evaluate the immediate and mid-term survival and, most of all, the frailty of patients older than 80 years after an AVR for severe aortic stenosis.

Section snippets

Patients

From April 1998 to December 2001, all 84 octogenarians addressed in our institution for AVR with symptomatic aortic stenosis were studied (representing 21% of all procedures of AVR in our institution during the study period).

Data collection

The following characteristics were recorded: age, sex, NYHA functional classification, chronic obstructive pulmonary disease (COPD), chronic renal failure (clearance < 30 ml/min), peripheral vascular disease, sinus rhythm, mean trans-aortic gradient, aortic valve area, left

Characteristics

Pre- and intra-operative characteristics of the 84 patients above 80 years addressed for AVR with aortic stenosis are detailed in Table 1. Postoperative evolution is detailed in Table 2. Most common complications were transfusion (48.8%) and a new onset of supra-ventricular arrhythmia (45.2%). Hospital mortality was 16.7% (10.2% in isolated AVR and 25.7% in AVR and CABG, p = 0.06). Principal causes of death were low cardiac output (n = 8) and septic shock (n = 3).

Mid-term survival and functional evolution

Follow-up was completed for all the

Discussion

This study showed that AVR for severe aortic stenosis in octogenarians can be achieved with a good mid-term survival, an important relief of cardiac symptoms, a good self-rated quality of life and health status, but this population is frail after the intervention as indicated by the high rate of geriatric symptoms.

With the increasing life expectancy (Pison, 2005) and the high prevalence of aortic stenosis in older people (Lindroos et al., 1993), we are and will be more frequently confronted

Conclusion

AVR for severe aortic stenosis can be achieved with an acceptable postoperative morbidity and mortality rate in octogenarians; mid-term survival is good with a relief of cardiac symptoms but this selected elderly population remains frail as assessed by the high rate of geriatrics symptoms; further studies in octogenarians should evaluate the impact of a specific geriatric managing on QoL and frailty after cardiac surgery.

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Estudo unicêntrico e retrospetivo com octogenários submetidos a cirurgia de SVA por EA grave isolada entre 2011 e 2015. A qualidade de vida foi avaliada pelo questionário Short Form (SF)‐36 no pré‐operatório (PREOP), aos 3, 6 e 12 meses após cirurgia. As oito dimensões e as duas componentes do SF‐36 foram comparadas no PREOP e no pós‐operatório com a comparação múltipla anova one‐way.
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A cirurgia de SVA melhorou o estado de saúde físico e mental dos octogenários com EA, sendo essa melhoria evidente aos três meses e consistente aos 6 e 12 meses.
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In a single‐center retrospective study of octogenarians undergoing isolated SAVR for symptomatic AS between 2011 and 2015, quality of life was assessed using the Medical Outcomes Study Short Form (SF‐36) at baseline and at three, six and 12 months after surgery. Scores for the eight domains and two components of the SF‐36 were compared at baseline and in the postoperative period by one‐way analysis of variance.
Over a five‐year period, 163 octogenarians underwent SAVR, of whom 3.1% died in the hospital. Deceased patients and those who did not complete the SF‐36 were excluded. A total of 81 patients were included, mean age 83 ± 2 years, 63% female, 60.5% in NYHA class II or higher and 19.7% with left ventricular systolic dysfunction. The mean logistic EuroSCORE was 10.7 ± 5.1%. In the hospital, 1.2% suffered stroke, 1.2% received a permanent implantable pacemaker and 23.5% presented atrial fibrillation. In the assessment of quality of life, improvement was seen in all SF‐36 domains (p< 0.002) and in the physical component (p< 0.001) at three, six and 12 months compared to baseline. The mental component also showed improvement, which was significant at six months (p = 0.011).
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Frailty after aortic valve replacement (AVR) in octogenarians

Abstract

Introduction

Section snippets

Patients

Data collection

Characteristics

Mid-term survival and functional evolution

Discussion

Conclusion

J. Am. Coll. Cardiol.

Ann. Thorac. Surg.

Ann. Thorac. Surg.

Am. J. Cardiol.

Ann. Thorac. Surg.

Ann. Thorac. Surg.

J. Am. Coll. Cardiol.

J. Am. Coll. Cardiol.

Cardiac operations in patients 80 years old and older

Ann. Thorac. Surg.

Screening for depression in primary care with two verbally asked questions: cross sectional study

Br. Med. J.

Circulation

To operate or not on elderly patients with aortic stenosis: the decision and its consequences

Heart

Decision-making and outcomes in severe symptomatic aortic stenosis

J. Heart Valve Dis.

L’autonomie des personnes de 80 ans et plus

Gérontologie et Société

Surgery for aortic stenosis in severely symptomatic patients older than 80 years: experience in a single UK centre

Heart