Isolated Aortic Valve Replacement in Octogenarians Compared to Septuagenarians: Five-Year Experience of a Single Centre

Abstract

Background: Prevalence of symptomatic aortic disease has increased significantly in recent years as the population ages. The introduction of trans-catheter aortic valve implantation adds another dimension to the management in high risk patients. This motivated us to review the characteristics and outcomes of surgical aortic valve replacement (AVR) in elderly patients Methods: Consecutive patients having isolated AVR during 2007-2011 in over 70 years olds at Auckland City Hospital were divided into 70-79 years and ≥80 years agegroups for analysis. Results: Sixty-two octogenarians and 121 septuagenarians were included. Octogenarians had significantly lower proportion with Canadian Cardiovascular Society Class 3-4 (3.2% vs 14.0%, p = 0.022), diabetes (11.3% vs 24.8%, p = 0.034) and mechanical valve used (1.6% vs 10.7%, p = 0.037), but higher proportion with infective endocarditis (6.5% vs 0.0%, p = 0.012) and higher EuroSCORE II (4.9% vs 3.7%, p < 0.001). Despite this, operative mortality was significantly lower in octogenarians (0.0% vs 7.4%, p = 0.029), although length of hospital stay post-operatively (11.7 vs 8.9 days, p = 0.026) was significantly greater. One, three and five year survival rates were 95.2%, 90.1% and 75.3% for octogenarians and 89.2%, 81.7% and 70.2% for septuagenarians (p = 0.398). Canadian Cardiovascular Society Class 3-4 and the presence of other valvular stenosis or regurgitation were independent predictors of both operative mortality and mortality during follow-up. Conclusion: Octogenarians had lower operative mortality despite higher EuroSCOREs. AVR is a safe operation in octogenarians when carefully selected, and factors beyond age and EuroSCORE, such as frailty, can be important considerations in the decision for which intervention to offer.