Combined Aortic Root and Aortic Valve Surgery in Elderly Patients

Objectives: Combined replacement of the aortic root and the aortic valve with a bioprosthetic composite prosthesis (bio-ARR) is the most widely accepted treatment for aortic dilatation and valvular pathology in the elderly. However, valve-sparing aortic root replacement (VSARR) is a promising option to avoid prosthesis-related complications, especially in patients with anulus dilatation and without relevant cusp pathology. The aim of this study is to compare the outcome between bio-ARR and VSARR in patients over 70 years of age and the need for aortic root replacement.

Methods: From September 2009 to September 2019, a total of 113 patients older than 70 years at the time of surgery underwent bio-ARR (group I, n = 53) or VSARR (group II, n = 60) and were retrospectively analyzed.

Result: Mean age at surgery was 76.4 ± 4.1 years in group I and 75.2 ± 3.3 years in group II (p = n.s.), and 62% were men in both groups. Acute aortic dissection rate was comparable between groups (19 vs. 20%, p = n.s.). Intensive care unit stay was 4 ± 6.3 days in group I and 4.7 ± 7 days in group II (p = n.s.). The total length of hospital stay did not differ between the two groups. Also no difference was observed for stroke, re-thoracotomy and pacemaker implantation rates. Eight patients (15.1%) died in group I while only 4 (6.7%) patients died in group II (p = n.s.) during hospital stay. Most of these patients (75% in both groups) suffered from acute aortic dissection. Follow-up was performed in of all patients. Mean follow-up was 30 ± 26 months. At midterm follow-up (30 ± 26 months, complete for n = 81 [80.2%]), overall survival did not differ significantly between groups (bio-ARR = 29 [94%] vs. VSARR = 43 [86%], p = n.s.).

Conclusion: Our results suggest that VSARR is not inferior to bio-ARR in carefully selected elderly patients requiring aortic root replacement. Although surgically more challenging, in experienced hands VSARR can be a safe and feasible treatment option even for elderly patients.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021