ANZ journal of surgery · 2023
A contemporary evaluation of surgical aortic valve replacement outcomes and temporal trends.
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Chang Shantel, Yong Matthew S, Stroebel Andrie, Hughes Ian, Scuffham Paul, He Cheng
Аннотация
BACKGROUND: Given the ageing population and uptake of transcatheter approaches for treating aortic stenosis (AS), a renewed evaluation of outcomes after surgical aortic valve replacement (SAVR) is warranted. With guidelines recommending age-based indications for surgical and transcatheter approaches, this study critically evaluates outcomes in age-based subgroups, with the aim to refine management of AS in the elderly, where there is often no clear consensus.
METHODS: Six hundred and thirteen consecutive patients who underwent SAVR in an Australian tertiary cardiac centre between 1 June 2014 and 13 January 2022 were retrospectively analysed. Of these, 70.31% were <75 years (Group 1) and 29.69% were ≥75 years (Group 2). Groups were compared with respect to early and long-term outcomes. Logistic regression, Kaplan-Meier survival estimates and Cox proportional hazards regression were performed for all patients and an AS-specific sub-group.
RESULTS: Patients aged ≥75 years were more likely to be female and have hypercholesterolemia, hypertension, and pre-existing arrhythmia (P < 0.001). Group 1 experienced a higher incidence of renal failure compared with Group 2, in the overall cohort and AS-specific subgroup (P = 0.02). The incidence of stroke was similar between groups, in the overall cohort (P = 0.22) and the AS-specific subgroup (P = 0.32). Age ≥ 75 was not found to be an independent predictor of 30-day, 1-year or 5-year mortality. Temporal trends revealed low consistently low complication rates.
CONCLUSIONS: Elderly patients should not be denied surgery based on age, despite guideline-driven age-based recommendations.
METHODS: Six hundred and thirteen consecutive patients who underwent SAVR in an Australian tertiary cardiac centre between 1 June 2014 and 13 January 2022 were retrospectively analysed. Of these, 70.31% were <75 years (Group 1) and 29.69% were ≥75 years (Group 2). Groups were compared with respect to early and long-term outcomes. Logistic regression, Kaplan-Meier survival estimates and Cox proportional hazards regression were performed for all patients and an AS-specific sub-group.
RESULTS: Patients aged ≥75 years were more likely to be female and have hypercholesterolemia, hypertension, and pre-existing arrhythmia (P < 0.001). Group 1 experienced a higher incidence of renal failure compared with Group 2, in the overall cohort and AS-specific subgroup (P = 0.02). The incidence of stroke was similar between groups, in the overall cohort (P = 0.22) and the AS-specific subgroup (P = 0.32). Age ≥ 75 was not found to be an independent predictor of 30-day, 1-year or 5-year mortality. Temporal trends revealed low consistently low complication rates.
CONCLUSIONS: Elderly patients should not be denied surgery based on age, despite guideline-driven age-based recommendations.