Long-term survival after aortic valve replacement in octogenarians and high-risk subgroups

Posted On 2012-11-19 10:36:59
A recent paper in the European Journal of Cardiothoracic Surgery describes long-term outcome after surgical aortic valve replacement (1). The investigators from Norway, state that the increasing age of our populations and improvements in the treatment options for aortic valvular disease have resulted in a considerable rise in the number of elderly patients being admitted for conventional aortic valve surgery. Recently, transcatheter aortic valve implantation (TAVI) has been developed as a less invasive treatment option. However, both open-heart surgery and transcatheter treatment have serious complications. Thus, the knowledge of contemporary results of conventional surgery is important in guiding treatment allocation.

The authors identified 1525 patients from a database at Feiring Heart Clinic, who had undergone aortic valve replacement from 1999 to 2010; of these, 361 patients were more than 80 years of age. The population was followed for all-cause mortality until March 2011, with special reference to the age group older than 80 years and other high-risk subsets.

The short-term mortality was 2.2% in the whole population and 3.9% in octogenarians. Five-year survival was 83.1 and 68.1%, respectively. In the high-risk subgroup of patients with a logistic EuroSCORE above 20%, the equivalent figures were 4.2 and 72.7%.

The authors conclude that contemporary results after conventional aortic valve surgery are excellent in both short- and long-term survival and should not be withheld in the elderly or otherwise high-risk populations. The authors state that the logistic EuroSCORE grossly overestimates the operative risk and should be used with caution in allocating patients to TAVI instead of conventional surgery.


References:
  1. Mølstad P, Veel T, Rynning S.Long-term survival after aortic valve replacement in octogenarians and high-risk subgroups.Eur J Cardiothorac Surg. 2012 Dec;42(6):934-40. PMID: 22551963 
  2. Beller CJ. Transapical aorticvalve implantation – What have we learnt? Quo vadis? CardiovascDiagnTher 2012 Oct 30. DOI: 10.3978/j.issn.2223-3652.2012.10.08http://www.thecdt.org/article/view/1174
  3. Holzhey DM, Hänsig M, Walther T, Seeburger J, Misfeld M, Linke A, Borger MA, Mohr FW. Transapical aortic valve implantation - The Leipzig experience. Ann CardiothoracSurg 2012;1(2):129-137. DOI: 10.3978/ j.issn.2225-319X.2012.06.09