Key result
Isolated primary SAVR in older patients yields 1.7% 30-day mortality.
Why the study?
With the advent of TAVI and lower-risk trials leading to expectations of declining SAVR use, this study aimed to examine real-world outcomes following SAVR in patients over the age of 60.
Cohort (n=1,005)
Surgical aortic valve replacement in patients over 60 years old demonstrates excellent real-world outcomes with low 30-day mortality and high 2-year survival.
Supports favorable real-world SAVR outcomes in older adults; extends registry data but leaves open comparative effectiveness versus TAVR.
OBJECTIVE: With the advent of transcatheter aortic valve implantation (TAVI) has come an expectation that there will be a decline in surgical aortic valve replacement (SAVR). This has been fueled by trials comparing outcomes between TAVI and SAVR in lower-risk patients. The aim of this study was to examine outcomes following SAVR in patients over the age of 60. MATERIALS AND METHODS: This retrospective cohort study observed 1005 patients ≥60 who underwent isolated primary SAVR from January 2015 to December 2018. The cohort was stratified by surgical risk, defined as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II < 4 versus ≥4. The cohort was also divided by age (60-69, 70-79, ≥80) for additional comparisons. Outcomes included in-hospital complications and patient survival. RESULTS: The median age and EuroSCORE II were 75 years and 1.6, respectively. The overall 30-day mortality was 1.7% and increased significantly with surgical risk (p = .007). The 30-day mortality of elective patients was 1.1%. Overall, 1- and 2-year survival rates were 94.3% and 91.7%, respectively, which significantly decreased with surgical risk (p < .001) and age (p = .002, p = .003). The rates of postoperative stroke and pacemaker implantations were 1.2% and 3.6%, respectively. CONCLUSIONS: SAVR can be performed in patients ≥60 years old with excellent outcomes, which compare favorably with outcomes from TAVI trials, with their highly selected patient cohorts. SAVR remains a reliable, tried and tested, treatment option in these patients.
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Sumal et al. (2021) conducted a cohort in Aortic valve disease requiring replacement (n=1,005). Surgical aortic valve replacement (SAVR) was evaluated on 30-day mortality. In patients aged ≥60 years undergoing isolated primary surgical aortic valve replacement, overall 30-day mortality was 1.7%, with 1- and 2-year survival rates of 94.3% and 91.7%.
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