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Aortic Valve Replacement in Octogenarians: impact on age-expected survival
Session:
SESSÃO DE POSTERS 04 - AMILOIDOSE E AORTA
Speaker:
Rui Cerqueira
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.2 Cardiovascular Surgery – Valves
Session Type:
Cartazes
FP Number:
---
Authors:
Rui Cerqueira; Francisca Saraiva; Cândida Gonçalves; Lívia Torres; Inês Sousa; Sílvia Diaz; Mário Jorge Amorim; Paulo Pinho; António Barros; André Lourenço; Adelino Leite-Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background: </strong>Despite the growing use of transcatheter aortic valve implantation, the steady increase in life expectancy also makes the surgical aortic valve replacement (AVR) an increasingly used procedure. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objective: </strong>To compare the survival of octogenarian patients undergoing isolated AVR with sex, race and aged-matched general population. Also to describe the need for reoperation and short-term hemodynamic data with Trifecta bioprosthesis in a single-center Tertiary Hospital</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>This is a longitudinal, retrospective, single-center study, including a consecutive sample of patients aged over 80 years who underwent isolated AVR surgery with Trifecta bioprosthesis, between 2011 and 2019. The primary outcome was long-term all-causes mortality (collected from the National Registry in December 2022). Hospital mortality was defined as death during hospitalization or up to 30 days after surgery. The survival curve in the octogenarian cohort (observed) was compared with the curve in the general population (expected), the latter collected from National Life tables from the National Institute of Statistics, specifically for the study's follow-up period (2011-2022). The software provided by the Massachusetts General Hospital Biostatistics Center and the R package "OneSampleLogRankTest" were used to compare the curves and apply the Log-Rank test and standardized mortality rate (matched for sex and age). The mean follow-up time was 4.5 years, and the maximum time was 10.2 years. Hemodynamic data were collected from the 1<sup>st</sup> transthoracic echocardiogram performed at a mean of 4 months postoperatively.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 163 octogenarian patients (mean age 82, maximum 89 years). The median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 2.36 (minimum: 0.98% and maximum: 13.16%). Most patients were female (67%), and the main pathology was aortic stenosis (87%). One-third of the patients had NYHA III-IV classification. Hospital mortality was 6%. After excluding these patients, the survival rate of the cohort undergoing AVR vs. expected in the population at 1st, 3rd, 5th, and 10th years were 93.5% vs. 93.7%, 86.3% vs. 79.5%, 67.8% vs. 63.4%, and 24.8% vs. 25.3%, respectively. The standardized mortality rate (0.92) revealed no significant differences between the observed and expected (confidence interval: 0.70-1.21, p = 0.49). Only one patient underwent a transcatheter valve-in-valve procedure due to structural valve deterioration at 4 years of follow-up. In the follow-up echocardiogram, the mean aortic valve gradient was 11 ± 4 mmHg, and the functional area was 2.0 ± 0.4 cm2.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>In a clinical scenario of our service, AVR surgery proved to be effective in the octogenarian cohort, as it was close to that expected in the national population. The study also reinforced the good hemodynamic profile of the prosthesis analyzed in this sample.</span></span></p>
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