Examining short-term and long-term outcomes in octogenarians undergoing isolated surgical aortic valve replacement

As the transcatheter approach to aortic valve disease become more common, the role of surgical aortic valve replacement (SAVR), particularly in older patients, is increasingly contentious. This study aimed to examine short-term and long-term outcomes in octogenarians undergoing isolated SAVR.

All consecutive patients aged 80 years and over undergoing isolated first-time SAVR in two cardiac surgery centres between 1997 and 2019 were included. Primary outcomes were in-hospital, 1-year and 5-year mortality and overall survival. Secondary outcomes were re-exploration, post-operative renal replacement therapy, post-operative stroke, post-operative permanent pacemaker implantation and post-operative length of stay (PLOS). The multivariate Cox regression analysis was used to identify variables independently associated with overall survival.

The study comprised 524 patients, which represented 14.9% of all isolated SAVRs performed during the study period (n = 524/3516). Mean age was 83.2 ± 2.7 years and 28.1% of patients (n = 147) were aged 85 years and above. 59.0% of patients (n = 309) were female. There were 11.1% of patients (n = 58) who underwent minimally invasive surgery and mean logistic EuroSCORE was 12.1% ± 6.6%. Median PLOS was 9 (7-14) days. Overall in-hospital, 1-year and 5-year mortality were 4.2% (n = 22), 9.7% (n = 51) and 34.5% (n = 181), respectively. For patients who survived to hospital discharge, 1-year survival was 94.2% (n = 473/502). Median follow-up time was 77 (44-101) months and estimated median overall survival was 81 (76-86) months.

SAVR remains a safe operation in octogenarian patients. Findings from this study suggest that for appropriately selected patients, SAVR can provide durable long-term benefit and should still be considered an appropriate treatment strategy.