Aortic valve replacement in patients over 60: Real‐world surgical outcomes

Abstract

Objective With the advent of transcatheter aortic valve implantation (TAVI) has come an expectation that there will be a decline in surgical aortic valve replacement (SAVR). This has been fueled by trials comparing outcomes between TAVI and SAVR in lower‐risk patients. The aim of this study was to examine outcomes following SAVR in patients over the age of 60. Materials and Methods This retrospective cohort study observed 1005 patients ≥60 who underwent isolated primary SAVR from January 2015 to December 2018. The cohort was stratified by surgical risk, defined as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II < 4 versus ≥4. The cohort was also divided by age (60–69, 70–79, ≥80) for additional comparisons. Outcomes included in‐hospital complications and patient survival. Results The median age and EuroSCORE II were 75 years and 1.6, respectively. The overall 30‐day mortality was 1.7% and increased significantly with surgical risk (p = .007). The 30‐day mortality of elective patients was 1.1%. Overall, 1‐ and 2‐year survival rates were 94.3% and 91.7%, respectively, which significantly decreased with surgical risk (p < .001) and age (p = .002, p = .003). The rates of postoperative stroke and pacemaker implantations were 1.2% and 3.6%, respectively. Conclusions SAVR can be performed in patients ≥60 years old with excellent outcomes, which compare favorably with outcomes from TAVI trials, with their highly selected patient cohorts. SAVR remains a reliable, tried and tested, treatment option in these patients.