Long-term survival after surgical aortic valve replacement in patients aged 80 years and over

Abstract

OBJECTIVES Surgical aortic valve replacement can be safely performed in people aged 80 years and older with early benefits on both symptomatic and prognostic ground. While new approaches are advocated to treat this elderly and frail population, data on long-term outcomes are not available. METHODS We conducted a retrospective analysis of 1870 patients aged 80 years and over who underwent first time surgical aortic valve replacement during the period 2000–2019. The Kaplan–Meier method was used to calculate survival and comparisons among groups were performed by log-rank test. Cox analysis was used to determine the independent risk factors for late mortality. RESULTS The patients’ mean age was 84 years and 53% were male. Isolated aortic valve replacement was performed in 42% of the patients, and coronary artery bypass grafting (n = 956), mitral valve (n = 94) or aortic surgery (n = 69) were associated in the remaining cases. One hundred eighty-one patients (8%) sustained at least 1 postoperative complication (reopening for bleeding or tamponade 3%, renal replacement therapy 3%, new cerebral stroke 1.5%). In-hospital mortality was 3.2% in the overall population (60/1870) and 2.2% after isolated aortic valve replacement (18/790). Survival was 90%, 66%, 31% and 14% at 1, 5, 10 and 15 years, respectively, and was similar to the expected survival of a sex- and age-matched population (log-rank P = 0.96). A complicated postoperative course was an independent risk factor for mortality during the follow-up [hazard ratio 1.32 (1.03, 1.68), P = 0.026]. CONCLUSIONS Surgical aortic valve replacement can be performed with an acceptable early mortality rate and provides excellent long-term survival in people aged 80 years and older.

Re‐sternotomy for aortic valve replacement in octogenarian patients in age of evolving transcatheter therapies

“…Results of SAVR in octogenarians are well documented but data on re‐sternotomies in octogenarians remains sparse 13 . Timek et al 14 reported a perioperative mortality of 1.6% in 3735 patients (mean age 83 ± 2 years) over 8 years with comparable long‐term survival (median survival – 7.8 years).…”

Early- and mid-term outcomes of reinterventions for aortic bioprosthesis failure

“…A total of 125 patients were included (redo-SAVR; 84, ViV-TAVI; 41). Median age was 74 [63-80] years, 58% of the patients were male and the median logistic EuroSCORE was 15 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]%. Median follow-up was 4.2 (2.2-6.8) years; redo-SAVR: 4.9 (2.1-7.8) years, ViV-TAVI: 3.5 (2.2-4.6) years.…”

“…8 Redo operations account for technical complexity and longer surgical times, they carry a higher risk of postoperative complications that we have previously shown being independently associated with a dismal survival in elderly patients undergoing aortic valve replacement. 21 In the setting of high risk, frail and older patients, even more so in presence of patent coronary artery bypass grafts, ViV-TAVI might be the preferred option for isolated aortic valve reintervention due to bioprosthesis failure. 8,18 Younger patients could also benefit from the avoidance of surgical trauma aiming for a shorter hospital stay, reduced transfusion, a prompt recovery and a faster return to the normal activity.…”

Early and long-term outcomes of re-sternotomy for aortic valve replacement with patent coronary artery grafts

“…These mortality rates are still remarkably high compared to isolated first-time AVR with mortality of 0.5%-1.9%. [9][10][11][12] In addition to the hazard of surgery itself, there may also be the additional hazard associated with long-standing ischemic heart disease in combination with aortic valve disease. Our analysis showed that the long-term survival of patients undergoing first-time isolated AVR approaches that of an age-matched general population whereas it lags behind significantly after a re-sternotomy AVR in patients with previous surgical myocardial revascularization.…”