The Impact of Age on Aortic Root Replacement

Aortic root replacement is increasingly being performed in the treatment of aortic root and valve pathology. While many of these procedures are performed during the fifth or sixth decade of life, differences in outcomes based on age remain largely unknown. Therefore, we examined short- and long-term outcomes of root replacement stratified by age.

From 2004 to 2021, all adult patients undergoing aortic root replacement in a retrospective database were included.

A total of 2748 patients were divided into 6 age groups: 18-29 (n = 163.6%), 30-39 (n = 286.10%), 40-49 (n = 451.16%), 50-59 (n = 628.23%), 60-69 (n = 741.27%), 70-79 (n = 386.14%), and ≥80 years (n = 93.3%). The mean age of the cohort was 55 years, and 81% were male. Valve-sparing root replacement and mechanical Bentall utilization decreased with age. The overall stroke rate was 3.4% and significantly higher among the ≥80 group (9.7%, P = .01). The ≥80 group had significantly more complications, including renal failure on dialysis, prolonged ventilation, longer hospital stays, and higher in-hospital mortality (13%). Four percent of patients required reoperation of the proximal aorta or aortic valve during follow-up, with rates of reoperation highest among 30-39-year (7.3%) and 40-49-year (5.8%) age groups. Ten-year survival was 78% (95% CI, 76%-80%) overall and worse among groups 70-79 (63%) and ≥80 (49%) compared to other groups (P < .0001).

Aortic root replacement can be performed across all adult ages with acceptable clinical results; however, operative outcomes and long-term survival were significantly worse in patients ≥80 years old. The decision to perform aortic root replacement in patients beyond the seventh decade of life should be made with critical analysis of the clinical indications and overall risk:benefit ratio.