Surgical aortic valve replacement above guideline age:reasons and clinical outcomes

Objectives:The 2017 and 2021 ESC/EACTS guidelines for the management of valvular heart disease recommend transcatheter aortic valve implantation (TAVI) as a treatment option for severe symptomatic aortic valve stenosis (AS) in patients ≥75 years of age. However, surgical aortic valve replacement (SAVR) remains a viable option for elderly patients, particularly in specific anatomical or clinical subsets. The objective of this study was to analyze indications for SAVR and postoperative outcomes in patients ≥75 years of age. Methods:Between 2017 and 2022, 43 patients underwent isolated SAVR. Indications included low operative risk (51.2%), bicuspid valve (21%), patient preference (13.9%), and challenging anatomy (13.9%). Outcomes followed VARC-3 criteria. Results:Technical success was 100%, with 0% 30-day mortality and low PPM (4.6%). ICU and hospital stays averaged 2.9 and 12.5 days, respectively. Cardiovascular mortality was 4.6% over 5.5 years. Conclusions:SAVR remains a viable option in select elderly patients with complex anatomy, achieving excellent outcomes when guided by heart team evaluations.