Objective

Aortic valve replacement (AVR) is the gold standard treatment for symptomatic severe aortic stenosis. However, Trans-catheter Aortic Valve Implantation (TAVI) has recently become preferable in octogenarians with previous cardiac surgery. We aim to compare the clinical outcomes following redo-AVR and TAVI in this group.

Methods

Our study included 58 patients older than 80 years with previous cardiac surgery who underwent redo-AVR (N=35) or TAVI (N=23) between 2005 and 2015. Mean age for AVR patients was 83±3 compared to 84±2 years in the TAVI patients (p=0.48). All surgical patients had isolated redo-AVR. Previous cardiac surgery was CABG in 22 (95%) TAVI patients and in 19 (54%) AVR patients. TAVI access was trans-femoral in 35% patients and trans-apical in 65% patients. Baseline characteristics and procedural complications were recorded.

Results

Left ventricular systolic function was moderate or severe in 7 TAVI patients (30%) versus 5 AVR patients (14%) (p=0.18). Logistic EuroSCORE was similar between the two groups (30.7±15.1 for AVR vs 28.4±10.8 for TAVI, p=0.5). 30-day mortality was higher in the TAVI cohort (8.7% vs 2.9%, p= 0.15). 1-year mortality was not different between AVR and TAVI (14.3% vs 8.7%, p=0.69). Pacemaker implantation and CVA were more frequent after AVR (11.3% vs 4.4%, p =0.63) and (5.7% vs 0%, p=0.51). Mild para-prosthetic regurgitation was significantly higher after TAVI (43% vs 3%, p<0.001). All patients presented over the last year underwent TAVI.

Conclusion

In octogenarians with previous cardiac surgery, surgical AVR seems to have similar short and mid-term survival compared to TAVI. However, postoperative morbidity was more frequent in the surgical group. With the recent advances in TAVI technology, TAVI is now the preferred approach in this elderly population at our centre.