Five year contemporary study of aortic valve replacement in octogenarians and septuagenarians

Abstract

Purpose: The demand for symptomatic aortic disease intervention has increased significantly in recent years as the population ages. This, together with the recent introduction of trans-catheter aortic valve implantation (TAVI), motivates a review of the characteristics and outcomes of surgical aortic valve replacement (AVR) in elderly recipients. Methods: Consecutive patients over 70 years of age having isolated AVR during 2007-11 at the Hospital, Aukland City were retrospectively identified and divided into 70-79 years and ≥80 years age-groups for analyses Results: There were 62 octogenarians and 121 septuagenarians included. Octogenarians had significantly lower proportion with Canadian Cardiovascular Society Class 3-4 (3.2% vs 14.0%, p=0.022), diabetes (11.3% vs 24.8%, p=0.034) and mechanical valve used (1.6% vs 10.7%, p=0.037), but higher proportion with infective endocarditis (6.5% vs 0.0%, p=0.012) and higher EuroSCORE II (4.9% vs 3.7%, p<0.001). Despite this, operative mortality was significantly lower in octogenarians (0.0% vs 7.4%, p=0.029), although length of hospital stay post-operatively (11.7 vs 8.9 days, p=0.026) was significantly greater. One, three and five year survival rates were 95.2%, 90.1% and 75.3% for octogenarians and 89.2%, 81.7% and 70.2% for septuagenarians (p=0.398). Canadian Cardiovascular Society Class 3-4 and the presence of other valvular stenosis or regurgitation were independent predictors of both operative mortality and mortality during follow-up. Conclusion: Octogenarians had lower operative mortality despite higher predicted risk pre-operatively. Other factors beyond age and EuroSCOR, such as frailty, can be important in deciding whether elderly patients should undergo AVR, and when appropriately selected, AVR is a safe operation in octogenarians.