Conventional Aortic Valve Replacement Remains a Safe Option in Patients Aged ≥70 Years: A 20-Year Experience

Background and aim of the study: Increased life expectancy has resulted in the elderly frequently presenting with severe aortic stenosis. It has therefore become important to define indications for conventional aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) in this patient population. Thus, patients aged ≥70 years undergoing conventional isolated AVR were evaluated for predictors of early and late mortality.
Methods: A retrospective analysis was conducted of prospectively collected data available from 1,061 consecutive patients (age range: 70-94 years) who underwent isolated AVR between 1982 and 2002. The patient age groups were 70-74 years (n = 466), 75-79 years (n = 367), and ≥80 years (n = 228). The mean follow up was 6.0 ± 4.4 years, and the total follow up 6,390 patient-years. Twenty-two variables were considered as potential risk factors for early and late mortality.
Results: Early mortality was higher in patients aged ≥80 years than in those aged 70-79 years. Early mortality in patients aged ≥80 years was lower between 1998 and 2002 than between 1982 and 1997. Multivariate predictors of early mortality were age

≥80 years, operative status, previous intervention, renal failure, and mitral regurgitation. The early non-fatal complication rate was similar for patients aged 70-79 years and ≥80 years, but late mortality was lower between 1998 and 2002 than between 1982 and 1997 in patients aged 70-79 years, and in those aged ≥80 years. The 10-year actuarial survivals after AVR in patients aged 70-74, 75-79, and ≥80 years were 54 ± 3.0%, 43 ± 3.8% and 17 ± 3.9%, respectively. Multivariate predictors of late mortality were age 75-79 years, age ≥80 years, peripheral vascular disease (PVD) and chronic obstructive pulmonary disease (COPD). Female gender was shown to be protective.
Conclusion: Early mortality was higher in patients aged ≥80 years undergoing AVR, though this has declined recently and is currently at an acceptable level. Other important predictors of mortality in elderly patients undergoing AVR are operative status, previous interventions, renal failure, mitral regurgitation, male gender, PVD, and COPD. Thus, conventional AVR remains a safe treatment option for the elderly patient.

The Journal of Heart Valve Disease 2012;21:148-155