Procedure-and age-specific risk stratification of single aortic valve replacement in elderly patients based on Japan adult cardiovascular surgery database

Nobuhiro Handa, Hiroaki Miyata, Noboru Motomura, Takeshi Nishina, Shinichi Takamoto

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Successful introduction of trans-catheter aortic valve implantation for selected patients with critical aortic stenosis has raised the question of how to identify appropriate high-risk candidates. Methods and Results: To assess the risk profile of patients undergoing single aortic valve replacement (sAVR), multiple logistic regression analysis was applied for open sAVR (n=7,883) registered in the Japan Cardiovascular Surgery Database to predict surgical mortality. Three subgroup analyses stratified by age, <70 years (young), 70-79 years (middle), and ≥80 years (elderly), were also performed. Preoperative patient characteristics indicated increased prevalence of several variables in the elderly subgroup including New York Heart Association (NYHA) class III/IV, 3-vessel coronary artery disease (3VCAD), respiratory insufficiency, and stroke. The following factors, however, were decreased in the elderly subgroup: dialysis, poor heart function, reoperation, renal dysfunction, and emergency surgery. Mortality was 3.0% in all sAVR patients and 5.2% in the elderly subgroup. Multivariate analysis in all patients produced 16 variables as operative risks (P<0.05) including respiratory insufficiency, dialysis, NYHA class III/IV, and reoperation. The analysis in the elderly subgroup produced 9 variables with more pronounced relative risk (RR), which included dialysis (RR=5.4), respiratory insufficiency (RR=3.3), preoperative arrhythmia (RR=3.0), 3VCAD (RR=3.6), and emergency surgery (RR=23.1). Conclusions: sAVR has produced good surgical results in Japan. Procedure-and age-specific analyses have identified a risk profile that is unique to sAVR patients in the elderly population in Japan.

Original languageEnglish
Pages (from-to)356-364
Number of pages9
JournalCirculation Journal
Volume76
Issue number2
DOIs
Publication statusPublished - 2012
Externally publishedYes

Fingerprint

Aortic Valve
Japan
Databases
Respiratory Insufficiency
Dialysis
Reoperation
Coronary Artery Disease
Emergencies
Mortality
Aortic Valve Stenosis
Cardiac Arrhythmias
Multivariate Analysis
Catheters
Logistic Models
Stroke
Regression Analysis
Kidney

Keywords

  • Risk factor
  • Surgery
  • Valvular disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Procedure-and age-specific risk stratification of single aortic valve replacement in elderly patients based on Japan adult cardiovascular surgery database. / Handa, Nobuhiro; Miyata, Hiroaki; Motomura, Noboru; Nishina, Takeshi; Takamoto, Shinichi.

In: Circulation Journal, Vol. 76, No. 2, 2012, p. 356-364.

Research output: Contribution to journalArticle

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AB - Background: Successful introduction of trans-catheter aortic valve implantation for selected patients with critical aortic stenosis has raised the question of how to identify appropriate high-risk candidates. Methods and Results: To assess the risk profile of patients undergoing single aortic valve replacement (sAVR), multiple logistic regression analysis was applied for open sAVR (n=7,883) registered in the Japan Cardiovascular Surgery Database to predict surgical mortality. Three subgroup analyses stratified by age, <70 years (young), 70-79 years (middle), and ≥80 years (elderly), were also performed. Preoperative patient characteristics indicated increased prevalence of several variables in the elderly subgroup including New York Heart Association (NYHA) class III/IV, 3-vessel coronary artery disease (3VCAD), respiratory insufficiency, and stroke. The following factors, however, were decreased in the elderly subgroup: dialysis, poor heart function, reoperation, renal dysfunction, and emergency surgery. Mortality was 3.0% in all sAVR patients and 5.2% in the elderly subgroup. Multivariate analysis in all patients produced 16 variables as operative risks (P<0.05) including respiratory insufficiency, dialysis, NYHA class III/IV, and reoperation. The analysis in the elderly subgroup produced 9 variables with more pronounced relative risk (RR), which included dialysis (RR=5.4), respiratory insufficiency (RR=3.3), preoperative arrhythmia (RR=3.0), 3VCAD (RR=3.6), and emergency surgery (RR=23.1). Conclusions: sAVR has produced good surgical results in Japan. Procedure-and age-specific analyses have identified a risk profile that is unique to sAVR patients in the elderly population in Japan.

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