PMID- 22112860
OWN - NLM
STAT- MEDLINE
DCOM- 20120529
LR  - 20190819
IS  - 1347-4820 (Electronic)
IS  - 1346-9843 (Linking)
VI  - 76
IP  - 2
DP  - 2012
TI  - Procedure- and age-specific risk stratification of single aortic valve 
      replacement in elderly patients based on Japan Adult Cardiovascular Surgery 
      Database.
PG  - 356-64
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.
FAU - Handa, Nobuhiro
AU  - Handa N
AD  - Department of Cardiovascular Surgery, National Hospital Organization, Nagara 
      Medical Center, Gifu, Japan. handa-kcgh @umin.ac.jp
FAU - Miyata, Hiroaki
AU  - Miyata H
FAU - Motomura, Noboru
AU  - Motomura N
FAU - Nishina, Takeshi
AU  - Nishina T
FAU - Takamoto, Shinichi
AU  - Takamoto S
CN  - Japan Adult Cardiovascular Database Organization
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111123
PL  - Japan
TA  - Circ J
JT  - Circulation journal : official journal of the Japanese Circulation Society
JID - 101137683
SB  - IM
MH  - Age Distribution
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/*mortality/*surgery
MH  - Databases, Factual/statistics & numerical data
MH  - Female
MH  - Heart Valve Prosthesis Implantation/*mortality
MH  - Humans
MH  - Japan/epidemiology
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - *Models, Statistical
MH  - Morbidity
MH  - ROC Curve
MH  - Risk Assessment/methods
MH  - Risk Factors
MH  - Sex Distribution
EDAT- 2011/11/25 06:00
MHDA- 2012/05/30 06:00
CRDT- 2011/11/25 06:00
PHST- 2011/11/25 06:00 [entrez]
PHST- 2011/11/25 06:00 [pubmed]
PHST- 2012/05/30 06:00 [medline]
AID - JST.JSTAGE/circj/CJ-11-0979 [pii]
AID - 10.1253/circj.cj-11-0979 [doi]
PST - ppublish
SO  - Circ J. 2012;76(2):356-64. doi: 10.1253/circj.cj-11-0979. Epub 2011 Nov 23.