Early outcomes following multivalve heart operation in octogenarians

Despite the rising incidence and complexity of valvular disease in the elderly population, data regarding surgical outcomes in octogenarians remain limited.

In this single-center, retrospective review of octogenarians who underwent simultaneous multivalve operations at our institution between 2019 and 2025, the primary outcome was in-hospital mortality. Secondary outcomes included postoperative complications, intensive care unit (ICU) and total hospital length of stay (LOS), and discharge disposition. Univariable analyses were performed to assess factors associated with survival and factors associated with discharge disposition among survivors (home vs skilled nursing facility).

Forty-three patients (mean age, 82.0 years; 62.8% male; mean EuroSCORE II, 10.5%) underwent multivalve operations. At least 1 major comorbidity was present in all patients. Nine patients (20.9%) underwent redo sternotomy, and 6 (14%) underwent a triple-valve operation. In-hospital mortality occurred in 6 patients (14%). The need for mechanical circulatory support (MCS) was strongly associated with in-hospital mortality (P = .001), as were renal failure (P = .002), prolonged ventilation (P = .004), and prolonged ICU stay (P = .03). Redo sternotomy, triple-valve intervention, and concomitant coronary artery bypass grafting were not associated with increased mortality. Among 37 survivors, 21 (56.8%) were discharged home. Longer total LOS (P = .01), ICU LOS (P = .01), and transfusion requirement (P = .04) were significantly associated with skilled nursing facility (SNF) discharge.

Multivalve operations in select octogenarians are feasible with a multidisciplinary approach. Need for MCS, renal failure, prolonged ventilation, and ICU LOS were associated with in-hospital mortality. Among survivors, transfusion requirement and longer ICU and total hospital LOS were associated with discharge to an SNF rather than home.