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Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis
Christopher K Mehta1, Tom X Liu1, Levi Bonnell2
1Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.
The Annals of Thoracic Surgery
|January 29, 2024
Summary
Surgical aortic valve replacement (SAVR) volumes have declined, especially for older patients and those with tricuspid aortic valves. Younger patients with bicuspid aortic valves show better-than-expected outcomes, supporting SAVR as a preferred treatment.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Health Services Research
Background:
- Aortic stenosis management guidelines now stratify patients by age.
- Surgical aortic valve replacement (SAVR) trends and outcomes require evaluation based on age and aortic valve type.
Purpose of the Study:
- To evaluate age-stratified SAVR trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV).
- To compare observed to expected mortality ratios based on The Society of Thoracic Surgeons (STS) predicted risk.
Main Methods:
- Analysis of adults (≥18 years) undergoing SAVR for severe aortic stenosis from July 2011 to December 2022.
- Stratification by age (<65, 65-79, ≥80 years) and BAV/TAV status.
- Assessment of operative mortality, composite morbidity/mortality, and permanent stroke rates.
Main Results:
- Total SAVR volume decreased by 45%, with a 96% drop in patients ≥80 years.
- Bicuspid aortic valve prevalence was higher in younger patients (<65 years).
- Observed mortality was better than expected for BAV patients under 80 years.
Conclusions:
- Surgical aortic valve replacement volumes have decreased, particularly for elderly patients and those with TAV, in the transcatheter era.
- Younger patients with BAV demonstrate superior outcomes, supporting SAVR as the preferred treatment.
- Shared decision-making for aortic stenosis should consider these age- and valve-specific outcomes.
