Background
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.
Methods
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.
Results
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%).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: September 09, 2013
Accepted:
August 6,
2013
Received in revised form:
August 1,
2013
Received:
March 20,
2013
Identification
Copyright
© 2013 Published by Elsevier Inc. All rights reserved.
