An increasing number of very elderly patients aged ≥80 years will require aortic valve replacement (AVR) for severe aortic stenosis (AS). Many are classified as high-risk surgical candidates. Transcatheter aortic valve implantation (TAVI) has been proposed as an alternative to surgical AVR (SAVR) for high-risk patients. We evaluated early clinical outcomes of very elderly patients undergoing SAVR to optimise TAVI candidate selection.
We conducted a retrospective case review of 132 consecutive patients aged ≥80 years undergoing isolated SAVR (49 patients) or combined SAVR/CABG (83 patients) during February 2002–January 2010 at a single tertiary referral hospital. Risk for cardiac surgery was calculated using the logistic EuroSCORE (ESlog). Mortality and morbidity data were collected for the 30-day postoperative period.
Thirty-day mortality rate was 8.3% for patients undergoing SAVR (6.1% for isolated SAVR and 9.6% for SAVR/CABG). Permanent stroke occurred in 3.8% and renal insufficiency in 7.6% of the cohort. Thirty-five percent of patients had left ventricular ejection fraction <50%, 67% had advanced symptoms (NYHA class III or IV), and 42% of patients were stratified as high-risk (ESlog ≥ 20%).
SAVR can be performed in very elderly patients with acceptable operative morbidity and mortality. The outcomes at our institution are comparable to contemporary SAVR and TAVI outcomes.
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Published online: September 09, 2013
Accepted: August 6, 2013
Received in revised form: August 1, 2013
Received: March 20, 2013
© 2013 Published by Elsevier Inc. All rights reserved.