Résultats du remplacement valvulaire aortique isolé chez l’octogénaire : évaluation monocentrique périopératoire sur 769 patients entre 2002 et 2014

JCTCV:21(2)
Objective: To assess hospital morbi-mortality of isolated aortic valve replacement (AVR) in a monocentric cohort of octogenarians. Methods: Between 2002 and 2014, 769 octogenarian patients, male in 46.4% (n=357), with a mean age of 82.7±2.4 years [range: 80–94.4], underwent isolated AVR with implantation of a biological valvular prosthesis in our center. The main surgical indication was aortic stenosis in 79.3% of patients. Patients who underwent redo surgeries were excluded from the study. Results: The hospital mortality rate was 1.95% (n=15) with a Euroscore 2 average of 2.7±3 [range: 0.9–41.2]. Mean intensive care unit stay was 3.1 ±4.5 days with a total hospital stay of 13.5±7.9 days. The main postoperative complications included blood transfusion (62.5%), renal failure (15.6%) requiring dialysis in 2.7 % of the cases, para-prosthesis aortic insufficiency (1 to 2/4) (3.4%), prolonged artificial ventilation (>48h) (2.9%), pace-maker implantation (1.4%), stroke (1.2%) and mediastinitis (0.5%). Multivariate predictors of hospital mortality were cardiogenic shock (OR=34.8 [4.2–215.9]), and a BMI greater than 30 (OR 4.5 [1.3–16.2]). Conclusion: Currently, aortic valve replacement in octogenarians is a reliable surgery with a low hospital morbi-mortality rate. It also provides effective identification of patients at risk.