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. 2024 Dec-Dec;20(15-16):849-858.
doi: 10.1080/14796678.2024.2433827. Epub 2024 Nov 25.

Operation in the gray zone: is SAVR still useful in patients aged between 75 and 80 years?

Ivo Deblier  1 , Karl Dossche  1 , Anthony Vanermen  1 , Wilhelm Mistiaen  2
Affiliations

Operation in the gray zone: is SAVR still useful in patients aged between 75 and 80 years?

Ivo Deblier et al. Future Cardiol. 2024 Dec-Dec.

Abstract

Introduction: Aortic valve replacement is the only effective treatment for symptomatic aortic valve disease. Transcatheter implantation has been introduced as alternative for surgery (SAVR), but its penetration varied widely. For high-risk octogenarian patients, the advantages of TAVI are clear. Patients between 75 and 79 years of age could be considered as "the gray zone."

Methods: We compared the outcome of SAVR with or without concomitant procedures between patients younger than 75 versus 75-79 years for their preoperative profile, operative parameters, and postoperative outcomes.

Results: Older patients had a higher risk score with more cardiovascular comorbidity and renal dysfunction. They required more concomitant CABG but less mitral valve repair. Cardiopulmonary bypass time was similar. In-hospital complication rates, need for blood transfusion, and length of stay in intensive care unit were higher in older patients. Thirty-day mortality was not significantly increased, Euroscore II overestimated mortality in both age groups. Age over 75 years was not an independent predictor for mortality. Need for emergent SAVR was only predictive in the older group. Long-term survival was acceptable. Age over 75 years was not the dominant predictor.

Conclusions: SAVR remains a valid option to treat symptomatic aortic valve disease in the age group of 75-79.

Keywords: Surgical aortic valve replacement; mortality; patient age; predictors; risk factors.

Plain language summary

Symptomatic aortic valve disease is a highly lethal condition, and its only effective treatment is replacement of the diseased valve. Surgery is the oldest mode of treatment but carries a risk in older patients, although surgery has been performed with success in patients of 80 years and older. For these patient groups, the implantation of a valve prosthesis through a transcatheter approach is a less invasive alternative, while for younger and low-risk patients, surgery remains the most important option. Patients older than 75, but younger than 80 years could be considered as the “gray zone.” For this reason, we compared patients in this age category with patients younger than 75 years with respect to their preoperative profile (risk score and concomitant cardiac and non-cardiac diseases), operative data and postoperative outcomes (need for postoperative resources, postoperative complications, and mortality in the hospital and at long-term). We found that older patients had more concomitant heart conditions and worse kidney function. Their risk (Euro II) score was also higher. They also needed more coronary artery surgery. The older patient group suffered more complications but had no higher need for resources, except for blood transfusion. They also stayed one day longer within the intensive care unit. Hospital mortality in the older group was not significantly increased. The risk score overestimated mortality in both age groups. Long-term survival was favorable in both groups. The need for emergent surgery affected short- and long-term mortality only in the older age group.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Figures

Figure 1.
Figure 1.
Effect of age over 75 years on long-term survival after surgical aortic valve replacement.
See this image and copyright information in PMC

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