Outcomes of Surgical Aortic Valve Replacement in Octogenarians

• Published in: Heart, lung & circulation Vol. 22; no. 8; pp. 618 - 626
• Main Authors: Harris, Rebecca S., BA, MB, BS (Hons), Yan, Tristan D., PhD, FRACS, Black, Deborah, PhD, Bannon, Paul G., PhD, FRACS, Bayfield, Matthew S., FRACS, Hendel, P. Nicholas, FRACS, Wilson, Michael K., FRACS, Vallely, Michael P., PhD, FRACS
• Format: Journal Article
• Language: English
• Published: Australia Elsevier B.V 01.08.2013
• Subjects: Age Factors; Aged, 80 and over; Aortic Valve - surgery; Aortic valve replacement; Cardiovascular; Disease-Free Survival; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Male; Octogenarians; Pleural Effusion - etiology; Pleural Effusion - mortality; Pleural Effusion - surgery; Postoperative Complications - mortality; Postoperative Complications - surgery; Renal Insufficiency - etiology; Renal Insufficiency - metabolism; Renal Insufficiency - surgery; Retrospective Studies; Stroke - etiology; Stroke - mortality; Stroke - surgery; Survival Rate; Time Factors; Aortic valve replacement; Octogenarians
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2013.01.008

Background In the era of TAVI, there has been renewed interest in the outcomes of conventional AVR for high-risk patients. This study evaluates the short- and long-term outcomes of AVR in octogenarians. Methods A retrospective review was performed of all 117 patients aged ≥80 years who underwent AVR, (isolated AVR ( n = 60) or AVR + CABG ( n = 57),) from August 2005 to February 2011 at Royal Prince Alfred Hospital and Strathfield Hospital. Univariate analysis was used to compare pre- and post-operative variables between younger and older subgroups (age 80–84, n = 82; age 85–89, n = 35 respectively). Long-term survival data was obtained from the National Death Index at the Australian Institute of Health and Welfare and survival curves were constructed using the Kaplan–Meier method. Results The median age was 83 years (interquartile range, 81–85 years), 46.2% were females, the median EuroSCORE was 10.89% (interquartile range, 8.20–16.45%) and 16.2% of patients had a EuroSCORE ≥20%. The difference between subgroups for history of stroke was significant ( p = .042). Post-operative complications included pleural effusion (12.8%), new renal failure (4.3%) and respiratory failure (4.3%). The rate of major adverse events was extremely low, with no cases of stroke. The 30-day mortality rate was 3.4%. There was a significant difference between subgroups for 30-day mortality ( p = .007). 38.9% of patients were discharged home, 11.5% were transferred to another hospital and 38.9% spent a period of time in a rehabilitation institution post discharge. In terms of long-term survival, the six-month, one-year and three-year survival was 95.6%, 87.6% and 58.4% respectively. Conclusions Surgical AVR yields excellent short- and long-term outcomes for potentially high-risk, elderly patients.