Deleterious effects of loss of independence assessed with the KATZ index after aortic valve replacement in elderly patient

Introduction: Surgical operative risk of valvular replacement has been widely studied and it has been shown that postoperative complications incidence and mortality increase with patients’ age. The aim of this study was to assess among elderly patients whom underwent surgical aortic valve replacement using various scoring system and Geriatric Assessment Indexes to predict post-operative risk and long-term outcome. Methods and Results: We prospectively evaluated the incidence, over early and late results, of surgical scores and geriatric profile amid 122 intermediate-risk patients, aged 75 years or more who underwent surgical aortic valve replacement. In a univariate analysis, the EuroScore II (OR 1.73, 95% CI: 1.21-2.48, P =0.002), STS score (OR 1.39, 95% CI: 1.03-1.88, P = 0.03) and a Katz index ≤ 5 (limitation of at least one daily living activity) (OR 3.35, 95% CI: 1.08-10.35, P=0.03) were predictors of a 30-day unfavorable evolution. In a multivariate analysis, only surgical scores were predictive factors. At 6 months, 20 patients had deceased or had to be readmitted to hospital. At 10 years, survival was 48 % [IQR 39-57]. The Katz index ≤ 5 was the only geriatric test independent of an unfavorable outcome at 6 months (OR 4.51, 95% CI: 1.25-16.29, P = 0.02) and of a deleterious effect over long-term survival (OR 3.00, 95% CI: 1.58-5.69, P=0.001). Conclusion: In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.