Langanay T, et al. - The long-term results of conventional aortic valve replacement (AVR) in octogenarians were reported. Outcomes support the efficacy of AVR to treat aortic stenosis for all age groups. Conventional AVR provides an excellent quality of life and restores life expectancy among elderly people; surgery should not be denied only because of old age. They suggest considering percutaneous valve implantation in cases of non-operable or high-risk patients. However, for the majority of patients with aortic stenosis, open-heart surgery remains the treatment of choice.

Methods

• Between 1978 and 2011, researchers identified a total of 2,005 patients aged ≥ 80 years who underwent AVR for aortic stenosis at their institution.
• Extracardiac comorbidity was reported in 1,009 out of 2,005 (50%) patients and coronary lesions were reported in 650 out of 2,005 (32%) patients.
• Valve replacement was performed in 1,515 (76%) patients, and concomitant coronary artery bypass grafting was performed in 396 (19%) patients.
• In the database, data were collected at the time of surgery; regular update of data was performed by mailed questionnaires and telephone contact.

Results

• For the last 10 years, early mortality of isolated AVR was 5.5% of the series.
• Chronic obstructive pulmonary disease, chronic renal failure, advanced cardiac disease (left or right ventricular failure, New York Heart Association Class IV and atrial fibrillation) and coronary disease were the significant risk factors.
• Long-term follow-up was 99.5% complete (nine patients lost to follow-up), totaling 8,849 patient-years.
• Death was reported in 901 patients at late follow-up with a median survival of 7.1 years; seven patients became centenarian.
• Apart from older age, the main late causes of death included cardiovascular (20.5%), neurological deficit (10.2%) and cancer (10.2%).
• At 2, 5 and 10 years, actuarial survival was 83%, 62.5% and 25%, respectively.
• In this study, this survival compares favorably with that of a French-matched population.
• Above all, functional improvement was reported in 90% of late survivors.
• As per univariable and multivariable analysis, risk factors of late death included male gender, associated comorbidity, renal failure, advanced cardiac disease, atrial fibrillation and impaired ventricular function.