Abstract 12319: Aortic Valve Replacement in Octogenarians with Prior Cardiac Surgery
Objective Trans-catheter aortic valve replacement has been advocated for very elderly patients with aortic stenosis (AS) and prior cardiac surgery as a less invasive treatment option. Although surgical aortic valve replacement (AVR) is safe and effective in selected elderly patients, the peri-operative and long term outcomes of AVR in very elderly with prior cardiac surgery are unknown.
Methods The Society of Thoracic Surgeons (STS) Database at our center enrolled 3,735 patients after AVR since 1996. In this time interval, we identified 61 patients 80 years and older who underwent AVR for severe AS or failed aortic bioprosthesis after having prior cardiac surgery. All clinical parameters were derived from the STS database. Follow-up mortality was assessed using the Social Security Death Index.
Results The average age of the patients was 83±2 years, 77% were male, and 74% underwent isolated CABG as their first cardiac procedure. The mean EF was 53±13%. CABG was performed concurrently in 49% of patients at the time of re-do sternotomy and AVR. Stented bioprosthesis was implanted in 61% of patients and stentless in 39%. Peri-operative mortality was 1.6% (1/61). One, three, five, and seven year survival rates were 88%, 82%, 73%, and 60%, respectively. Median survival was 7.8 years. Patients with AVR only had significantly better survival than patients who underwent concomitant AVR and CABG (Figure). Type of aortic prosthesis did not influence post-operative survival.
Conclusions In selected patients over the age of 80 with history of prior cardiac surgery, AVR can be performed safely with good mid and long term outcomes although need for conccurrent CABG negatively influences survival. Age alone should not be an exclusion criteria for surgical AVR in octogenarians with prior cardiac surgery.
- © 2012 by American Heart Association, Inc.