Contemporary Surgical Aortic Valve Replacement in Elderly Patients

Background: Surgical Aortic Valve Replacement (SAVR) has steadily declined in importance due to the increasing use of transcatheter Aortic Valve Implantation (TAVI) in patients across all risk-strata. Due to large randomized controlled trials comparing SAVR and TAVI current guidelines still recommend SAVR for patients <75 years of age and at low surgical risk. The aim of this study was to compare patients <75 years and ≥75 years of age undergoing isolated SAVR in a single center patient cohort.

Methods: From 03/2018 to 10/2022, 344 patients undergoing isolated SAVR were enrolled in Hamburg Harbor registry. Of those, 275 patients were <75 years of age (group 1, 62.5 ± 10.9 years) and were compared to 69 patients ≥75 years (group 2, 78.9 ± 2.9 years, p ≤ 0.01). Acute procedural and early clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. Patients with acute endocarditis were included.

Results: Patients ≥75 years presented a higher risk profile according to STS risk stratification (group 1 vs. group 2, 0.9 ± 1.1 vs. 1.8 ± 1.6%, p ≤ 0.01). Aortic regurgitation as leading cause for SAVR was significantly more present in patients <75 years of age (40.5 vs. 23.9%, p ≤ 0.01). No significant difference was found regarding prevalence of infective endocarditis (13 vs. 12.7%, p = 1.0). Procedural data revealed no differences in cardiopulmonary bypass time (98 ± 45 vs. 89 ± 25 minutes, p = 0.11) and cross clamp time (67 ± 27 vs. 61 ± 31 minutes, p = 0.18). Rates of stroke (2.17 vs. 1.31%, p = 1.0), acute renal failure (5.5 vs. 7.0%, p = 0.77), new permanent pacemaker implantation (PPI) (6.8 vs. 5.6%, p = 1.0) and intensive care unit stay (2 ± 2.3 vs. 2 ± 2.1 days, p = 1.0) were comparable between groups. Mean 30-day aortic valve gradients (11.6 ± 5.1 mmHg vs. 11.1 ± 4.4 mmHg, p = 0.44) and rates of paravalvular leakage >mild (0 vs. 1.4%, p = 0.2) showed favorable hemodynamic results in both groups. Despite >10% of endocarditis patients in both groups, rates of 30-day mortality were low (1.8 vs. 1.4%, p = 1.0).

Conclusion: Both patient cohorts presented excellent outcomes with low rates of mortality, stroke and PPI despite a significant proportion of patients with infective endocarditis in both groups. Decision to provide patients with SAVR or TAVI within a heart team should be based on a multifactorial decision process including anatomical parameters, clinical condition and considerations regarding lifetime management of aortic valve disease.

 

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

Publication History

Article published online:
13 February 2024