Thorac Cardiovasc Surg 2014; 62 - OP122
DOI: 10.1055/s-0034-1367196

Outcome of redo surgical aortic valve replacement in patients aged more than 80 years: Results from the multicenter RECORD initiative

G. Santarpino 1, F. Onorati 2, F. Biancari 3, G. Mariscalco 4, M. De Feo 5, A. Messina 6, F. Santini 7, C. Beghi 4, G. Nappi 5, G. Troise 6, G. Passerone 7, J. Heikkinen 3, G. Faggian 2, T. Fischlein 1
  • 1Klinikum Nürnberg, Cardiac Surgery, Nürnberg, Germany
  • 2University of Verona Medical School, Cardiac Surgery, Verona, Italy
  • 3University of Oulu, Cardiac Surgery, Oulu, Finland
  • 4Varese University Hospital, Varese, Italy
  • 5Second University of Naples, Department of Cardiothoracic and Respiratory Sciences, Napoli, Italy
  • 6Poliambulanza Foundation Hospital, Brescia, Cardiac Surgery, Brescia, Italy
  • 7San Martino University Hospital Genoa, Cardiac Surgery, Genoa, Italy

Objectives: Octogenarians undergoing surgical redo-aortic valve replacement (REDO-AVR) are expected to be at high risk of adverse events, a finding that has recently popularized Transcatheter Aortic Valve Implantation (TAVI) in this cohort.

Methods: This multicenter study evaluates the outcome of 744 patients (99 aged 80 years or older) who underwent REDO-AVR after prior cardiac surgery. The outcome between older and younger patients was compared in the entire cohort and in a propensity-matched population.

Results: Octogenarians and younger patients had similar immediate outcome (in-hospital mortality: 3.0% vs. 5.9%%, p = 0.34; stroke: 5.1% vs. 6.7%, p = 0.66, dialysis: 9.1% vs. 6.5%, p = 0.34). Similar findings were observed in 84 propensity score-matched pairs. Patients ≥80 years-old had a similar survival compared to younger patients (5-year survival: 83.1% vs. 78.0%, p = 0.68, propensity score adjusted: RR 0.23, 95%C.I. 0.59-1.88). Octogenarians and younger patients had similar freedom from heart failure episodes (at 5-year, 84.5% vs. 89.2%, p = 0.311, propensity score adjusted: RR 1.37, 95%C.I. 0.62-3.04) and freedom from reoperation (at 5-year, 94.9% vs. 97.9%, p = 0.51, propensity score adjusted: RR 1.93, 95%C.I. 0.35-10.56). However, patients ≥80 years old had poorer freedom from late stroke (at 5-year, 89.8% vs. 97.5%, p = 0.016, propensity score adjusted: RR 6.137, 95%C.I. 1.776-21.208) and peripheral thrombo-embolism (at 5-year, 90.0% vs. 98.2%, p = 0.003, propensity score adjusted: RR 4.00, 95%C.I. 1.07-15.00).

Conclusion: Octogenarians undergoing REDO-AVR have immediate postoperative outcome similar to younger patients, and their 5-year outcome is excellent. Indication to TAVI should not rely on the simple existence of REDO-surgery and old age.