Age matters? Investigating VARC-3 outcomes in surgical aortic valve reoperations: a multicenter study

Background Redo surgical aortic valve replacement (rSAVR) is known to carry higher operative risk compared with first-time aortic valve surgery. Evidence on how age influences outcomes following rSAVR remains scarce. This study aimed to evaluate clinical outcomes after rSAVR, with a focus on the role of age. Methods We retrospectively reviewed all adult patients who underwent rSAVR in four centers between January 2015 and December 2022. The primary endpoint was Valve Academic Research Consortium-3 (VARC-3) periprocedural mortality. The impact of age on survival was assessed using univariable Cox regression analysis. Results A total of 215 patients were included (63% male; median age 69 years, IQR 59–75). Previous biological prostheses were present in 165 cases (77%). The median EuroSCORE II was 4.8% (IQR 3.0–8.1). Indications for reoperation included structural valve deterioration in 100 patients (46%), endocarditis in 87 (40%), and paravalvular leak in 14 (7%). Concomitant procedures were performed in 96 patients (45%), and 39 (18%) underwent urgent surgery. A biological valve was implanted in 159 patients (74%). Periprocedural VARC-3 mortality occurred in 22 cases (10%). Age showed no significant effect on periprocedural mortality (OR 0.87, 95% CI 0.53–1.42, p = 0.42). During follow-up (median 4 years, IQR 2–5), overall survival was 86% (95% CI 81–91) at 1 year and 78% (95% CI 72–85) at 5 years. Age showed a significant non-linear association with late death at follow-up (p = 0.012), with a change-point at 70 years above which the risk increased progressively (HR 2.64, 95% CI 1.04–6.71 for an 85- vs. 70-year-old patient). Conclusions In our multicenter experience, rSAVR remains associated with relevant periprocedural risk. Age does not influence early VARC-3 mortality, but patients aged 70 years or older, as expected, show increased long-term mortality.