AGE IS NOT JUST A NUMBER FOR A RAPID DEPLOYMENT VALVE IN OCTOGENARIANS

Authors

  • Tiago R. Velho Cardiothoracic Surgery Department, Hospital de Santa Maria – CHLN, Lisboa, Portugal; Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
  • Nuno Carvalho Guerra Cardiothoracic Surgery Department, Hospital de Santa Maria – CHLN, Lisboa, Portugal
  • Hugo Ferreira Cardiothoracic Surgery Department, Hospital de Santa Maria – CHLN, Lisboa, Portugal
  • Rafael Maniés Pereira Cardiothoracic Surgery Department, Hospital de Santa Maria – CHLN, Lisboa, Portugal
  • André Sena Cardiothoracic Surgery Department, Hospital de Santa Maria – CHLN, Lisboa, Portugal
  • Ricardo Ferreira Cardiothoracic Surgery Department, Hospital de Santa Maria – CHLN, Lisboa, Portugal
  • Ângelo Nobre Cardiothoracic Surgery Department, Hospital de Santa Maria – CHLN, Lisboa, Portugal

DOI:

https://doi.org/10.48729/pjctvs.29

Abstract

Introduction: Aortic valve stenosis (AS) is the most common valvular pathology in the elderly and surgery (AVR) remains the gold-standard. However, transcatheter aortic valve replacement (TAVI) has become an emerging alternative to surgery. In a recent survey from the European Society of Cardiology, 9,4% stated that age was the main reason to propose for TAVI.

Methods: Single-center retrospective study including 353 patients (149 ≥80 years-old;204 with 60-69 years-old) submitted to AVR between 2013-2016. Primary endpoint was survival. Secondary outcomes included the rate of post- -operative complications. Long-term survival was determined by Kaplan-Meier survival analysis. Continuous variables were analyzed with t-test and linear regression and categorical variables with chi-square or Fisher.

Results: clinical characteristics were similar between the two groups. Both had similar survival at 30 days, 12 (93,29% 60-69yo vs 91,47% ≥80yo) and 24 months (88,34% 60-69yo vs 86,11% ≥80yo). However, rapid deployment valves (RD) had better survival rates in elderly patients. Cross-clamp time was lower in ≥80yo group, with higher percentage of RD valves (20,1% vs 4.9% in 60-69yo). The rate of post-operative atrial fibrillation was higher in >80yo group (29,06% vs. 17,28%,p=0,0147). In all patients, cross-clamp time was directly related to ventilation time(p=0,025) and chest drainage(p=0,0015).

Conclusion: AVR after 80yo is safe. Cross-clamp time is directly correlated with ventilation time and bleeding, with a stronger correlation in patients over 80yo. RD valves reduce cross-clamp times, so their use in elderly may improve surgery outcome. Prospective studies are needed to evaluate if age may be clinical criteria for a RD.

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Published

17-04-2021

How to Cite

1.
Velho TR, Carvalho Guerra N, Ferreira H, Maniés Pereira R, Sena A, Ferreira R, Nobre Ângelo. AGE IS NOT JUST A NUMBER FOR A RAPID DEPLOYMENT VALVE IN OCTOGENARIANS. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Apr. 17 [cited 2022 Dec. 8];27(3):191-7. Available from: https://pjctvs.com/index.php/journal/article/view/29

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