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Thorac Cardiovasc Surg
DOI: 10.1055/a-2724-5108
Original Cardiovascular

Surgical aortic valve replacement above guideline age:reasons and clinical outcomes

Authors

  • Johannes Petersen 

    1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany

  • Harun Sarwari

    2   University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany (Ringgold ID: RIN196169)

  • Oliver D Bhadra

    3   Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany (Ringgold ID: RIN196169)

  • Till Demal

    4   Department of cardiovascular surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany (Ringgold ID: RIN196169)

  • Simon Pecha 

    5   Dapartment of Cardiovascular Surgery, University Heart Center, 20246, Germany

  • Hermann Reichenspurner

    3   Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany (Ringgold ID: RIN196169)

  • Andreas Schaefer

    1   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Objectives:The 2017 and 2021 ESC/EACTS guidelines for the management of valvular heart disease recommend transcatheter aortic valve implantation (TAVI) as a treatment option for severe symptomatic aortic valve stenosis (AS) in patients ≥75 years of age. However, surgical aortic valve replacement (SAVR) remains a viable option for elderly patients, particularly in specific anatomical or clinical subsets. The objective of this study was to analyze indications for SAVR and postoperative outcomes in patients ≥75 years of age. Methods:Between 2017 and 2022, 43 patients underwent isolated SAVR. Indications included low operative risk (51.2%), bicuspid valve (21%), patient preference (13.9%), and challenging anatomy (13.9%). Outcomes followed VARC-3 criteria. Results:Technical success was 100%, with 0% 30-day mortality and low PPM (4.6%). ICU and hospital stays averaged 2.9 and 12.5 days, respectively. Cardiovascular mortality was 4.6% over 5.5 years. Conclusions:SAVR remains a viable option in select elderly patients with complex anatomy, achieving excellent outcomes when guided by heart team evaluations.



Publication History

Received: 15 February 2025

Accepted after revision: 15 October 2025

Accepted Manuscript online:
18 October 2025

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