Re-sternotomy for aortic valve replacement in octogenarian patients
Submission category -- Original article
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.