Urgent surgical aortic valve replacement significantly increased 30-day mortality compared to elective surgery (16.4% vs 3.3%; OR 4.03), with the highest risk observed in patients over 85 years.
Cohort (n=2,500)
No
How do age and the need for urgent surgical aortic valve replacement affect 30-day mortality and long-term survival?
Advanced age (>80 years) and the need for urgent SAVR are dominant predictors of poor short- and long-term survival, emphasizing the need for timely elective valve replacement before compensatory mechanisms are exhausted.
Odds Ratio: 4.03 (95% CI 2.63–6.17)
Absolute Event Rate: 16.4% vs 3.3%
p-value: p=<0.001
Age and the need for urgent surgical aortic valve replacement (SAVR) could affect 30-day mortality and long-term survival. These factors were assessed in a stratified manner to assess the subsequent effects on these outcomes. A retrospective chart review was performed in patients undergoing SAVR. Urgent SAVR was defined as the need for surgery during admission in patients diagnosed with aortic valve disease. Preoperative predictors of urgent SAVR were identified by entering significant factors into a logistic regression model. Predictors of 30-day mortality were identified in parallel stratified analyses by age (85 years) and operative status (elective vs. urgent). The effect of age groups on long-term mortality, stratified by operative status, was assessed using Kaplan–Meier analysis. Predictors of this outcome were identified using Cox proportional hazards analysis. Cardiac factors were the main predictors of the need for urgent SAVR, whereas age had an effect only in univariate analysis. Thirty-day mortality increased significantly in patients older than 80 years, which was central to the subsequent age-stratified analyses. The need for urgent SAVR was the dominant predictor of mortality across all age groups. Conversely, age over 80 years was the dominant predictor of 30-day mortality in patients undergoing both elective and urgent SAVR. Advanced age and the need for urgent SAVR reduced long-term survival to a comparable degree, but only age was identified as an independent predictor. The need for urgent surgery in patients older than 85 years was associated with very poor short-term and long-term survival outcomes. The need for urgent SAVR likely represents exhaustion of the cardiac compensatory mechanisms required to maintain adequate circulation. With increasing age, patients become more vulnerable to the need for urgent SAVR. This condition should be avoided through timely valve replacement.
Mistiaen et al. (Wed,) conducted a cohort in Aortic valve disease requiring surgical aortic valve replacement (n=2,500). Urgent surgical aortic valve replacement vs. Elective surgical aortic valve replacement was evaluated on 30-day mortality (OR 4.03, 95% CI 2.63-6.17, p=<0.001). Urgent surgical aortic valve replacement significantly increased 30-day mortality compared to elective surgery (16.4% vs 3.3%; OR 4.03), with the highest risk observed in patients over 85 years.
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