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Re-sternotomy for aortic valve replacement in octogenarian patients Submission category -- Original article
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  • Suvitesh Luthra,
  • Pietro Giorgio Malvindi,
  • Hannah Masraf,
  • Anna Podonyi,
  • Taha Ramadan,
  • Sunil Ohri
Suvitesh Luthra
University Hospital Southampton NHS Foundation Trust
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Pietro Giorgio Malvindi
University Hospital Southampton NHS Foundation Trust
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Hannah Masraf
University of Southampton
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Anna Podonyi
University Hospital Southampton NHS Foundation Trust
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Taha Ramadan
University Hospital Southampton NHS Foundation Trust
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Sunil Ohri
University Hospital Southampton NHS Foundation Trust
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Abstract

Background The aim of this study was to analyse the perioperative results and long term survival of re-sternotomy for surgical aortic valve replacement (SAVR) in octogenarians. Methods This is a retrospective, single centre study (Apr 2000 – Dec 2019). Perioperative data were compared for re-sternotomy with isolated SAVR (Isolated redoSAVR) and re-sternotomy with SAVR and concomitant cardiac procedure (Associated redoSAVR). Regression analyses were performed to identify predictors of in patient mortality. Hazard ratios were calculated, and Kaplan Meier survival curves were compared for groups. Results There were 163 patients (Isolated redoSAVR; 69, Associated redoSAVR; 94). Mean age was 83±3 years and mean logEuroSCORE was 21±12. Follow up was 4.2±3.5 years. Inpatient mortality was 4.9% (1.4% versus 7.4% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.08). TIA/stroke rate was 8% (9% versus 7% for Isolated redoSAVR and Associated redoSAVR respectively, p=0.78). COPD was a predictor of inpatient mortality (OR; 8.86, 95%CI; 1.19, 66.11, p=0.03). Survival was 88.7% at 1 year, 86.4% at 2 years, 70.1% at 5 years, 49.5% at 7 years and 26.3% at 10 years. There was no survival difference between Isolated redoSAVR and Associated redoSAVR (logrank p=0.36, Wilcoxon p=0.84). Significant predictors of adverse long term survival were COPD, postoperative TIA/stroke and length of stay. Survival is lower than age and gender matched first time SAVR and general population of UK. Conclusions RedoSAVR in octogenarians is associated with acceptable but significant morbidity and mortality. Shared decision making should consider emerging transcatheter therapies as viable options in selected patients.
17 Nov 2021Submitted to Journal of Cardiac Surgery
17 Nov 2021Submission Checks Completed
17 Nov 2021Assigned to Editor
19 Nov 2021Reviewer(s) Assigned
15 Dec 2021Review(s) Completed, Editorial Evaluation Pending
15 Dec 2021Editorial Decision: Revise Minor
02 Jan 20221st Revision Received
03 Jan 2022Assigned to Editor
03 Jan 2022Submission Checks Completed
03 Jan 2022Reviewer(s) Assigned
06 Jan 2022Review(s) Completed, Editorial Evaluation Pending
07 Jan 2022Editorial Decision: Revise Minor
11 Jan 20222nd Revision Received
12 Jan 2022Submission Checks Completed
12 Jan 2022Assigned to Editor
12 Jan 2022Reviewer(s) Assigned
19 Jan 2022Review(s) Completed, Editorial Evaluation Pending
19 Jan 2022Editorial Decision: Accept