Why the study?
European guidelines recommend transcatheter aortic valve implantation from age 75 based on limited evidence, prompting evaluation of minimally invasive isolated aortic valve replacement outcomes in patients aged ≥ 75 compared to younger patients.
Does minimally invasive isolated aortic valve replacement yield comparable short-term outcomes in patients aged ≥ 75 years compared to those < 75 years?
Does minimally invasive isolated aortic valve replacement yield comparable short-term outcomes in patients aged ≥ 75 years compared to those < 75 years?
Minimally invasive aortic valve replacement demonstrates comparable short-term safety and mortality in patients aged ≥ 75 years compared to younger patients, suggesting age alone should not preclude surgical intervention.
Comparable short-term outcomes support considering minimally invasive AVR in select patients ≥75; leaves open whether guidelines should revisit age thresholds.
(1) Background and Objectives: Transcatheter aortic valve implantation is guideline-recommended from the age of 75. However, this European guideline recommendation is based on limited evidence, since no interaction between age and primary outcome has been found in guideline-stated references. This study aimed to compare the short-term outcomes of minimally invasive isolated aortic valve replacement in patients aged ≥ 75 with those of younger patients; (2) Patients and Methods: This retrospective cohort study included 1339 patients who underwent minimally invasive isolated aortic valve replacement at our facility between 2014 and 2022. This cohort was divided into two age-based groups: <75 and ≥75 years. Operative morbidity and mortality were compared between groups. Further analysis was performed using propensity score matching; (3) Results: After matching, 347 pairs of patients were included and analyzed. Despite the higher EuroSCORE II in the ≥75 group (2.2 ± 1.3% vs. 1.80 ± 1.34%, p ≤ 0.001), the 30-day mortality (1.4% vs. 1.2%; p = 0.90) and major adverse cardiac and cerebrovascular events, such as perioperative myocardial infarction (0.0% vs. 1.2%, p = 0.12) and stroke (1.4% vs. 2.6%, p = 0.06), were comparable between both treatment groups; (4) Conclusions: Minimally invasive aortic valve replacement is a safe treatment method for patients aged ≥ 75. Our results indicate that the unilateral cut-off of 75 years is not a limiting factor for performing minimally invasive aortic valve replacement.
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Taghizadeh‐Waghefi et al. (2023) studied this question.
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