Reconstructive aortic valve surgery in the elderly: Techniques and outcomes

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 155; no. 4; pp. 1414 - 1420
• Main Authors: Urbanski, Paul P., Jankulovski, Atanas, Doldurov, Kiril, Zhan, Xiaochun, Sodah, Ayman, Zacher, Michael, Diegeler, Anno
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2018
• Subjects: aortic root; aortic valve; surgery; valve repair; aortic root; aortic valve; TEE; VSRR; valve repair; surgery
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2017.11.096

The aim of the study was to evaluate operative techniques and long-term results after aortic valve or root repair in patients aged 75 years or more.
Between November 2002 and January 2016, a total of 815 patients underwent aortic valve or root repair. Among them were 100 patients aged 75 years or more (mean, 78 ± 3; range, 75-88 years), including 17 patients operated on an emergency basis because of acute aortic dissection. None/trivial, mild, moderate, and severe insufficiency grades were presented in 9, 23, 27, and 41 patients, respectively. The surgery comprised root repair, cusp repair, and a combination of both in 45, 16, and 39 patients, respectively.
Early (30-day) mortality and the rate of permanent neurologic deficit were 2% for each. The follow-up was 99% complete, resulting in 427 patient/years. During the follow-up period (mean duration, 4.3 ± 3.2; range, 0.02-11.1 years), only 1 patient developed a relevant aortic insufficiency and required aortic valve reoperation. There were 24 late deaths, which occurred on average 50.0 ± 40.6 months (range, 2.4-135.0) after surgery at the average patient age of 82 ± 5 years (range, 75-90). Estimated survival at 5 and 8 years was 76.4% ± 5.1% and 71.3% ± 5.9%, respectively, and was similar to those of the sex- and age-matched general population.
Reconstructive aortic valve surgery is a suitable and justifiable surgical option in selected elderly patients undergoing operation by surgeons with considerable experience in this kind of surgery. It offers low cardiac and valve-related mortality and morbidity, leading to life expectancy applicable to the patients' ages.