Objective

A decade ago, cardiac surgery in octogenarians was a relative rarity. Today, such surgery has ceased to be a novelty. In order to evaluate this changing pattern of practice, we have reviewed 30-day outcome for isolated first-time aortic valve replacement (AVR) in octo- and nonagenarians.

Methods

We performed a retrospective analysis of prospectively collected data for all patients over 80 years old who underwent isolated first-time AVR at our institution between August 2003 and September 2015. Pre-operative, intra-operative and post-operative variables were analyzed. Exclusion criteria included: re-do procedures, emergency procedures, and the of concomitant coronary artery bypass grafting (CABG).

Results

There were 219 patients. Median age was 82 years.& 43% were male. Median Logistic EuroSCORE I was 11.1%. 11.4% were recorded as having impaired left ventricular function. Surgery was urgent in 13.6%. Mean CPB and cross-clamp times were 72 and 52 minutes. 30-day all cause mortality was 1.8%. Complications were atrial fibrillation (44%), temporary renal dysfunction (8%), renal dialysis (4%), respiratory dysfunction (25%), stroke (1%), and bleeding (7%). Median hospital stay was 14 days.

Conclusion

Isolated 1st-time AVR can be performed in patients over 80 years of age with excellent early outcomes. However, morbidity is not negligible and lengths of stay long. Age alone should neither be a contraindication for AVR not should it, in of itself, be an indication for less invasive strategies which may be associated with inferior durability. Patient selection and appropriate multi-disciplinary evaluation of treatment strategies are the essential pre-requisites of good postoperative outcome.