Aortic valve replacement in patients over 60: Real-world surgical outcomes

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Geriatric Medicine

Background:

• Transcatheter aortic valve implantation (TAVI) is increasingly used, leading to expectations of reduced surgical aortic valve replacement (SAVR).
• Previous trials focused on TAVI vs. SAVR in lower-risk populations, leaving outcomes for older SAVR patients less defined.

Purpose of the Study:

• To evaluate the outcomes of surgical aortic valve replacement (SAVR) in patients aged 60 years and older.
• To compare SAVR outcomes in this demographic against expectations set by TAVI trials.

Main Methods:

• A retrospective cohort study of 1005 patients (≥60 years) undergoing isolated primary SAVR between 2015-2018.
• Patients were stratified by surgical risk (EuroSCORE II <4 vs. ≥4) and age groups (60-69, 70-79, ≥80).
• Outcomes assessed included in-hospital complications and patient survival rates.

Main Results:

• Overall 30-day mortality was 1.7%, increasing with surgical risk (p=.007). Elective SAVR had 1.1% 30-day mortality.
• One- and two-year survival rates were 94.3% and 91.7%, decreasing significantly with higher surgical risk and age.
• Postoperative stroke rate was 1.2%, and pacemaker implantation rate was 3.6%.

Conclusions:

• Surgical aortic valve replacement (SAVR) in patients aged 60 and above yields excellent outcomes.
• These results favorably compare to TAVI trials, particularly considering the highly selected TAVI cohorts.
• SAVR is confirmed as a reliable and effective treatment option for older patients requiring aortic valve replacement.