Francesco Onorati1, Fausto Biancari2, Marisa De Feo3, Giovanni Mariscalco4, Antonio Messina5, Giuseppe Santarpino6, Francesco Santini7, Cesare Beghi4, Giannantonio Nappi3, Giovanni Troise5, Theodor Fischlein6, Giancarlo Passerone7, Jeuni Heikkinen2, Giuseppe Faggian8. 1. Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. Electronic address: frankono@libero.it. 2. Division of Cardiac Surgery, University of Oulu, Oulu, Finland. 3. Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy. 4. Cardiac Surgery Unit, Varese University Hospital, Varese, Italy. 5. Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. 6. Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany. 7. Cardiac Surgery Unit, San Martino University Hospital, Genoa, Italy. 8. Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
Abstract
BACKGROUND: Octogenarians undergoing surgical aortic valve replacement (AVR) after prior cardiac surgery are expected to be at high risk of adverse events. This finding has recently popularized transcatheter AVR in this cohort. METHODS: This multicenter study includes 744 patients (99 were 80 years or older) who underwent surgical AVR after prior cardiac surgery. The outcome of octogenarians was compared with younger patients in the entire cohort and in a propensity score-matched population. RESULTS: Octogenarians and younger patients had similar immediate outcome (in-hospital mortality, 3.0% versus 5.9%; p=0.34; stroke, 5.1% versus 6.7%; p=0.66; dialysis, 9.1% versus 6.5%; p=0.34), as confirmed also in 84 propensity score-matched pairs. Octogenarians and younger patients had similar late survival (5-year survival, 83.1% versus 78.0%; p=0.68; propensity score-adjusted relative risk [RR], 0.23; 95% confidence interval [CI], 0.59 to 1.88). Octogenarians and younger patients had similar freedom from heart failure episodes (at 5 years, 84.5% versus 89.2%; p=0.311; propensity score-adjusted RR, 1.37; 95% CI, 0.62 to 3.04) and from reoperation (at 5 years, 94.9% versus 97.9%; p=0.51; propensity score-adjusted RR, 1.93; 95% CI, 0.35 to 10.56). However, octogenarians had poorer freedom from late stroke (at 5 years, 89.8% versus 97.5%; p=0.016; propensity score-adjusted RR, 6.137; 95% CI, 1.776 to 21.208) and peripheral thromboembolism (at 5 years, 90.0% versus 98.2%; p=0.003; propensity score-adjusted RR, 4.00; 95% CI, 1.07 to 15.00). CONCLUSIONS: Octogenarians undergoing surgical AVR after prior cardiac surgery have similar immediate postoperative outcome as younger patients, and their 5-year outcome is excellent. These data suggest that indications to undergo transcatheter AVR should not rely only on coexistence of advanced age and history of prior cardiac surgery.
BACKGROUND: Octogenarians undergoing surgical aortic valve replacement (AVR) after prior cardiac surgery are expected to be at high risk of adverse events. This finding has recently popularized transcatheter AVR in this cohort. METHODS: This multicenter study includes 744 patients (99 were 80 years or older) who underwent surgical AVR after prior cardiac surgery. The outcome of octogenarians was compared with younger patients in the entire cohort and in a propensity score-matched population. RESULTS: Octogenarians and younger patients had similar immediate outcome (in-hospital mortality, 3.0% versus 5.9%; p=0.34; stroke, 5.1% versus 6.7%; p=0.66; dialysis, 9.1% versus 6.5%; p=0.34), as confirmed also in 84 propensity score-matched pairs. Octogenarians and younger patients had similar late survival (5-year survival, 83.1% versus 78.0%; p=0.68; propensity score-adjusted relative risk [RR], 0.23; 95% confidence interval [CI], 0.59 to 1.88). Octogenarians and younger patients had similar freedom from heart failure episodes (at 5 years, 84.5% versus 89.2%; p=0.311; propensity score-adjusted RR, 1.37; 95% CI, 0.62 to 3.04) and from reoperation (at 5 years, 94.9% versus 97.9%; p=0.51; propensity score-adjusted RR, 1.93; 95% CI, 0.35 to 10.56). However, octogenarians had poorer freedom from late stroke (at 5 years, 89.8% versus 97.5%; p=0.016; propensity score-adjusted RR, 6.137; 95% CI, 1.776 to 21.208) and peripheral thromboembolism (at 5 years, 90.0% versus 98.2%; p=0.003; propensity score-adjusted RR, 4.00; 95% CI, 1.07 to 15.00). CONCLUSIONS: Octogenarians undergoing surgical AVR after prior cardiac surgery have similar immediate postoperative outcome as younger patients, and their 5-year outcome is excellent. These data suggest that indications to undergo transcatheter AVR should not rely only on coexistence of advanced age and history of prior cardiac surgery.
Authors: Francesco Onorati; Augusto D'Onofrio; Fausto Biancari; Stefano Salizzoni; Marisa De Feo; Marco Agrifoglio; Giovanni Mariscalco; Vincenzo Lucchetti; Antonio Messina; Francesco Musumeci; Giuseppe Santarpino; Giampiero Esposito; Francesco Santini; Paolo Magagna; Cesare Beghi; Marco Aiello; Ester Dalla Ratta; Carlo Savini; Giovanni Troise; Mauro Cassese; Theodor Fischlein; Mattia Glauber; Giancarlo Passerone; Giuseppe Punta; Tatu Juvonen; Ottavio Alfieri; Davide Gabbieri; Domenico Mangino; Andrea Agostinelli; Ugolino Livi; Omar Di Gregorio; Alessandro Minati; Mauro Rinaldi; Gino Gerosa; Giuseppe Faggian Journal: Interact Cardiovasc Thorac Surg Date: 2016-03-14
Authors: Maroun Yammine; Fernando Ramirez-Del Val; Julius I Ejiofor; Robert C Neely; Diana Shi; Siobhan McGurk; Sary F Aranki; Tsuyoshi Kaneko; Prem S Shekar Journal: Ann Cardiothorac Surg Date: 2017-09
Authors: Sophie Provenchère; Arnaud Chevalier; Walid Ghodbane; Claire Bouleti; Philippe Montravers; Dan Longrois; Bernard Iung Journal: PLoS One Date: 2017-11-16 Impact factor: 3.240