Age Is Not Just A Number For A Rapid Deployment Valve In Octogenarians

• Published in: Revista portuguesa de cirurgia cardio-torácica e vascular Vol. 27; no. 3; p. 191
• Main Authors: Velho, Tiago R, Carvalho Guerra, Nuno, Ferreira, Hugo, Pereira, Rafael Maniés, Sena, André, Ferreira, Ricardo, Nobre, Ângelo
• Format: Journal Article
• Language: English
• Published: Portugal 01.07.2020
• Subjects: Aged; Aged, 80 and over; Aortic Valve - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Middle Aged; Prospective Studies; Retrospective Studies
• ISSN: 0873-7215

Aortic valve stenosis (AS) is the most common valvular pathology in the elderly and surgery (AVR) remains the gold-standard. However, transcatheter aortic valve replacement (TAVI) has become an emerging alternative to surgery. In a recent survey from the European Society of Cardiology, 9,4% stated that age was the main reason to propose for TAVI. Single-center retrospective study including 353 patients (149 ≥80 years-old;204 with 60-69 years-old) submitted to AVR between 2013-2016. Primary endpoint was survival. Secondary outcomes included the rate of post- -operative complications. Long-term survival was determined by Kaplan-Meier survival analysis. Continuous variables were analyzed with t-test and linear regression and categorical variables with chi-square or Fisher. clinical characteristics were similar between the two groups. Both had similar survival at 30 days, 12 (93,29% 60-69yo vs 91,47% ≥80yo) and 24 months (88,34% 60-69yo vs 86,11% ≥80yo). However, rapid deployment valves (RD) had better survival rates in elderly patients. Cross-clamp time was lower in ≥80yo group, with higher percentage of RD valves (20,1% vs 4.9% in 60-69yo). The rate of post-operative atrial fibrillation was higher in >80yo group (29,06% vs. 17,28%,p=0,0147). In all patients, cross-clamp time was directly related to ventilation time(p=0,025) and chest drainage(p=0,0015). AVR after 80yo is safe. Cross-clamp time is directly correlated with ventilation time and bleeding, with a stronger correlation in patients over 80yo. RD valves reduce cross-clamp times, so their use in elderly may improve surgery outcome. Prospective studies are needed to evaluate if age may be clinical criteria for a RD.