Why the study?
Does conventional isolated aortic valve replacement achieve acceptable short-term and long-term survival in patients ≥80 years old compared to younger patients and the age-matched general population?
Does conventional isolated aortic valve replacement achieve acceptable short-term and long-term survival in patients ≥80 years old compared to younger patients and the age-matched general population?
Conventional isolated aortic valve replacement in octogenarians yields acceptable 30-day mortality and a 5-year survival rate comparable to the age-matched general population, supporting its continued role as a standard therapy.
Supports AVR in selected octogenarians; leaves open randomized comparisons with TAVR.
OBJECTIVE: The advent of percutaneous aortic valve implantation has increased interest in the outcomes of conventional aortic valve replacement in elderly patients. The current study critically evaluates the short-term and long-term outcomes of elderly (≥80 years) Australian patients undergoing isolated aortic valve replacement. METHODS: Data obtained prospectively between June 2001 and December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analysed. Isolated aortic valve replacement was performed in 2791 patients; of these, 531 (19%) were at least 80 years old (group 1). The patient characteristics, morbidity and short-term mortality of these patients were compared with those of patients who were <80 years old (group 2). The long-term outcomes in elderly patients were compared with the age-adjusted Australian population. RESULTS: Group 1 patients were more likely to be female (58.6% vs 38.0%, p<0.001) and presented more often with co-morbidities including hypertension, cerebrovascular disease and peripheral vascular disease (all p<0.05). The 30-day mortality rate was not independently higher in group 1 patients (4.0% vs 2.0%, p=0.144). Group 1 patients had an independently increased risk of complications including new renal failure (11.7% vs 4.2%, p<0.001), prolonged (≥24 h) ventilation (12.4% vs 7.2%, p=0.003), gastrointestinal complications (3.0% vs 1.3%, p=0.012) and had a longer mean length of intensive care unit stay (64 h vs 47 h, p<0.001). The 5-year survival post-aortic valve replacement was 72%, which is comparable to that of the age-matched Australian population. CONCLUSION: Conventional aortic valve replacement in elderly patients achieves excellent outcomes with long-term survival comparable to that of an age-adjusted Australian population. In an era of percutaneous aortic valve implantation, it should still be regarded as the gold standard in the management of aortic stenosis.
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Saxena et al. (2011) studied this question.
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