LONG-TERM SURVIVAL FOLLOWING AORTIC VALVE REPLACEMENT AMONG HIGH-RISK ELDERLY PATIENTS IN THE UNITED STATES: INSIGHTS FROM THE STS ADULT CARDIAC SURGERY DATABASE, 1991-2007

Abstract

Background —Surgical aortic valve replacement (AVR) remains the standard of care for the treatment of operable, symptomatic aortic valve disease; however, to date, there are limited national data on the contemporary long-term outcomes following AVR in older individuals. Methods and Results —We examined long-term survival among 145,911 AVR patients ≥65 years of age undergoing AVR at 1,026 centers with participation in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database from 1991-2007. In-hospital complications and long-term survival were stratified by age, STS perioperative risk of mortality (PROM), and several comorbidities. The median patient age was 76 years, with 16% having chronic lung disease, 6% preoperative renal failure, 38% heart failure, and 12% prior cardiac surgery. The median survival in patients aged 65-69, 70-79, and ≥80 years undergoing isolated AVR was 13, 9, and 6 years, respectively. For AVR plus coronary artery bypass graft (CABG) procedures, median survival was 10, 8, and 6 years, respectively. While only 5% of isolated AVR patients had a high STS PROM (≥10%), their median survival was 2.5 to 2.7 years. Severe lung disease and renal failure were each associated with a 50% or greater reduction in median survival among all age groups when compared with those who did not have these comorbidities, while left ventricular dysfunction and prior cardiac operation were associated with a 25% reduction in median survival. Conclusions —Long-term survival following surgical AVR in the elderly is excellent, although patients with a high STS PROM and those with certain comorbidities carry a particularly poor long-term prognosis.