Early and late outcomes of AVR with aortic annular enlargement in octogenarian.

Abstract

There is no clear consensus on the procedures for octogenarians with a small aortic annulus who require aortic valve replacement (AVR). We evaluated surgical results in octogenarians who underwent AVR with aortic annular enlargement, Nicks procedure, for aortic stenosis with a small aortic annulus. Between January 2001 and March 2014, 131 octogenarian patients were treated at our institution. Nineteen patients received AVR with aortic annular enlargement (AAE group), and the others received standard AVR without annular enlargement (sAVR group). We compared early and late outcomes between the two groups. There were no significant differences in early complications between the groups. The rates for use of a mechanical valve (32 vs 22 %, p = 0.590), in-hospital mortality (5.3 vs 5.4 %, p = 1.000), and severe patient-prosthesis mismatch (PPM) (0 vs 6.3 %, p = 0.593) were also similar between the AAE and sAVR group. In the AAE group, there was no cardiac-related death, bleeding event, thromboembolism, or stroke during the follow-up period (mean 37.6 months). The rates of freedom from cardiac events at 8 years were 94 % in the AAE group and 57 % in the sAVR group (p = 0.292). The overall survival rates at 8 years were 77 % in the AAE group and 77 % in sAVR group (p = 0.462). There were no significant differences in these rates between the groups. AVR with aortic annular enlargement in octogenarians with small aortic annulus was safe and led to good operative and long-term outcomes.