Early and mid-term results of isolated aortic valve replacement for aortic stenosis in octogenarians

As transcatheter aortic valve implantation (TAVI) may become a potential treatment for high-risk patients with aortic stenosis (AS), evaluation of outcomes after open aortic valve replacement (AVR) in elderly patients is warranted. We documented early and late outcomes after isolated AVR in octogenarians compared with younger age groups.

From January 2007 to December 2012, 136 patients underwent isolated AVR for AS (mean age 71.3 years, 39% males) and were classified into two groups (octogenarians and non-octogenarians). Twenty-four percent were aged 80 years or older. Forty-six percent of all patients were in New York Heart Association functional class III-IV. The estimated Society of Thoracic Surgeons and Japan operative mortalities were 3.4 and 2.5%, respectively.

The 30-day mortality was 0%. One in-hospital death occurred from low output syndrome and congestive heart failure in the non-octogenarian group. Postoperative morbidity was not statistically significant different between the age groups. All of the patients-with the exception of one case of in-hospital death and one patient who was transferred to another hospital-were discharged (postoperative length of stay, 16.4 days). The actuarial survival for 3 years by age group was 89.8% in octogenarians compared with 93.2% in non-octogenarians.

Recent results show that isolated AVR for severe AS can be performed with a low operative mortality and morbidity regardless of age. TAVI may be an alternative for high-risk patients, but isolated AVR remains the standard intervention for AS even in increased age.