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. 2021 Apr;36(4):1468-1476.
doi: 10.1111/jocs.15353. Epub 2021 Jan 24.

Aortic valve replacement in patients over 60: Real-world surgical outcomes

Anoop S Sumal  1 , Jason M Ali  2 , Harry Kyriacou  1 , Christopher J Tuttle  1 , Narain Moorjani  2
Affiliations

Aortic valve replacement in patients over 60: Real-world surgical outcomes

Anoop S Sumal et al. J Card Surg. 2021 Apr.

Abstract

Objective: With the advent of transcatheter aortic valve implantation (TAVI) has come an expectation that there will be a decline in surgical aortic valve replacement (SAVR). This has been fueled by trials comparing outcomes between TAVI and SAVR in lower-risk patients. The aim of this study was to examine outcomes following SAVR in patients over the age of 60.

Materials and methods: This retrospective cohort study observed 1005 patients ≥60 who underwent isolated primary SAVR from January 2015 to December 2018. The cohort was stratified by surgical risk, defined as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II < 4 versus ≥4. The cohort was also divided by age (60-69, 70-79, ≥80) for additional comparisons. Outcomes included in-hospital complications and patient survival.

Results: The median age and EuroSCORE II were 75 years and 1.6, respectively. The overall 30-day mortality was 1.7% and increased significantly with surgical risk (p = .007). The 30-day mortality of elective patients was 1.1%. Overall, 1- and 2-year survival rates were 94.3% and 91.7%, respectively, which significantly decreased with surgical risk (p < .001) and age (p = .002, p = .003). The rates of postoperative stroke and pacemaker implantations were 1.2% and 3.6%, respectively.

Conclusions: SAVR can be performed in patients ≥60 years old with excellent outcomes, which compare favorably with outcomes from TAVI trials, with their highly selected patient cohorts. SAVR remains a reliable, tried and tested, treatment option in these patients.

Keywords: TAVI; outcomes; surgical aortic valve replacement; survival.

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References

REFERENCES

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