Background Octogenarians undergoing surgical aortic valve replacement (AVR) after prior cardiac surgery are expected to be at high risk of adverse events. This finding has recently popularized transcatheter AVR in this cohort. Methods This multicenter study includes 744 patients (99 were 80 years or older) who underwent surgical AVR after prior cardiac surgery. The outcome of octogenarians was compared with younger patients in the entire cohort and in a propensity score-matched population. Results Octogenarians and younger patients had similar immediate outcome (in-hospital mortality, 3.0% versus 5.9%; p = 0.34; stroke, 5.1% versus 6.7%; p = 0.66; dialysis, 9.1% versus 6.5%; p = 0.34), as confirmed also in 84 propensity score-matched pairs. Octogenarians and younger patients had similar late survival (5-year survival, 83.1% versus 78.0%; p = 0.68; propensity score-adjusted relative risk [RR], 0.23; 95% confidence interval [CI], 0.59 to 1.88). Octogenarians and younger patients had similar freedom from heart failure episodes (at 5 years, 84.5% versus 89.2%; p = 0.311; propensity score-adjusted RR, 1.37; 95% CI, 0.62 to 3.04) and from reoperation (at 5 years, 94.9% versus 97.9%; p = 0.51; propensity score-adjusted RR, 1.93; 95% CI, 0.35 to 10.56). However, octogenarians had poorer freedom from late stroke (at 5 years, 89.8% versus 97.5%; p = 0.016; propensity score-adjusted RR, 6.137; 95% CI, 1.776 to 21.208) and peripheral thromboembolism (at 5 years, 90.0% versus 98.2%; p = 0.003; propensity score-adjusted RR, 4.00; 95% CI, 1.07 to 15.00). Conclusions Octogenarians undergoing surgical AVR after prior cardiac surgery have similar immediate postoperative outcome as younger patients, and their 5-year outcome is excellent. These data suggest that indications to undergo transcatheter AVR should not rely only on coexistence of advanced age and history of prior cardiac surgery. © 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc.
Outcome of redo surgical aortic valve replacement in patients 80 years and older: Results from the multicenter RECORD initiative
Mariscalco, Giovanni;Santini, Francesco;Passerone, Giancarlo;Faggian, Giuseppe
2014-01-01
Abstract
Background Octogenarians undergoing surgical aortic valve replacement (AVR) after prior cardiac surgery are expected to be at high risk of adverse events. This finding has recently popularized transcatheter AVR in this cohort. Methods This multicenter study includes 744 patients (99 were 80 years or older) who underwent surgical AVR after prior cardiac surgery. The outcome of octogenarians was compared with younger patients in the entire cohort and in a propensity score-matched population. Results Octogenarians and younger patients had similar immediate outcome (in-hospital mortality, 3.0% versus 5.9%; p = 0.34; stroke, 5.1% versus 6.7%; p = 0.66; dialysis, 9.1% versus 6.5%; p = 0.34), as confirmed also in 84 propensity score-matched pairs. Octogenarians and younger patients had similar late survival (5-year survival, 83.1% versus 78.0%; p = 0.68; propensity score-adjusted relative risk [RR], 0.23; 95% confidence interval [CI], 0.59 to 1.88). Octogenarians and younger patients had similar freedom from heart failure episodes (at 5 years, 84.5% versus 89.2%; p = 0.311; propensity score-adjusted RR, 1.37; 95% CI, 0.62 to 3.04) and from reoperation (at 5 years, 94.9% versus 97.9%; p = 0.51; propensity score-adjusted RR, 1.93; 95% CI, 0.35 to 10.56). However, octogenarians had poorer freedom from late stroke (at 5 years, 89.8% versus 97.5%; p = 0.016; propensity score-adjusted RR, 6.137; 95% CI, 1.776 to 21.208) and peripheral thromboembolism (at 5 years, 90.0% versus 98.2%; p = 0.003; propensity score-adjusted RR, 4.00; 95% CI, 1.07 to 15.00). Conclusions Octogenarians undergoing surgical AVR after prior cardiac surgery have similar immediate postoperative outcome as younger patients, and their 5-year outcome is excellent. These data suggest that indications to undergo transcatheter AVR should not rely only on coexistence of advanced age and history of prior cardiac surgery. © 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc.
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