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

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.