Long-term Outcomes in Octogenarians Following Isolated Aortic Valve Replacement

Isolated aortic valve replacement (AVR) in elderly patients is associated with increased operative risk, due to higher prevalence of associated risk factors and other comorbidities, making outcome prediction essential. In patients with symptomatic severe aortic disease, advanced age is often a reason for a transcatheter rather than surgical aortic valve replacement. In the era of TAVI, there has been renewed interest in the outcomes of conventional AVR for high and intermediate risk patients. This study evaluates the short and long-term outcomes of elective AVR in elderly patients.

Between July 2011 and May 2015, 100 patients, aged 80 years or older, underwent elective AVR in our unit. The notes of these patients were retrospectively reviewed and follow-up information was obtained from their cardiologists and general practitioners. The average age was 82.8±2.3 years, 53.0% were female, 96.0% had severe aortic valve stenosis and their mean EuroSCORE II was 4.1±3.2 (intermediate risk). Preoperatively, 35.0% of patients were in NYHA class III or IV. Statistical analyses were done using IBM SPSS version 24.

Median UCI and hospital stay was 2.0±3.7 and 7.0±9.5 days, respectively. Post-operatively, 2 patients required insertion of a permanent pacemaker, 3 patients suffered an ischemic stroke without sequelae, 3 required temporary renal replacement therapy, 7 required resternotomy for bleeding, 3 had sternal wound infections. No myocardial infarction was observed. In-hospital mortality was 4.0%, which was in accordance with the mean EuroSCORE II (4.1±3.2, p>0.05). One- year survival was 85.0%, three-year survival was 81.4% and five-year survival was 59.4%. At follow-up, 96.0% of patients were New York Heart Association (NYHA) Class I or II and 2 late endocarditis occurred and were medically treated. Structural valve deterioration was observed in 2 patients at 3 years follow-up.

The outcome after AVR in octogenarians is satisfactory; the operative risk is acceptable and might even be reduced with an individual approach to perioperative management in high-risk patients. Patient age should not be the primary exclusion for conventional cardiac surgery for aortic valve disease.