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Severe aortic stenosis in octogenarians – Is surgical aortic valve replacement a good option?
Session:
Painel 9 - Doença Valvular 1
Speaker:
Raquel Menezes Fernandes
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Raquel Menezes Fernandes; Hugo Alex Costa; João De Sousa Bispo; Teresa Faria Da Mota; Dina Bento; Nuno Marques; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction:</strong> Symptomatic severe aortic stenosis entails a high risk of morbidity and mortality without valve replacement, and increasing age is associated with higher surgical risk. This study aims to determine the prognostic impact of advanced age in patients with severe aortic stenosis referred to surgical valve replacement.</p> <p><strong>Methods: </strong>We conducted a retrospective study encompassing patients referred to surgical aortic valve replacement due to severe aortic stenosis, from January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Patients were divided in two groups according to the age: <80 and ≥80 years old. Independent predictors of mortality and/or re-hospitalization were identified through a binary logistic regression analysis, considering p=0,05.</p> <p><strong>Results:</strong> A total of 234 patients were included, with a 65,4% male predominance and a median age of 75,5 years old. 29,9% had concomitant surgical coronary artery disease and 88% waited in an out-patient setting. Median delay until surgery was 93 days and median follow-up after surgical referral was 525 days. 64 patients (27,4%) had ≥ 80 years old. Male gender (70,6% vs 51,6%; p=0,006), smoking habits (13,6% vs 1,6%; p=0,007), higher glomerular filtration rate (74,8 vs 61,3 ml/min; p<0,001) and lower Euroscore II values (2,86% vs 4,57%; p=0,002) were more common in younger patients. Only 7,8% of the older patients underwent transcatheter aortic valve implantation, after Heart Team discussion. Global mortality rate (26,6% vs 15,3%; p=0,047) and the composite of mortality or re-hospitalization (53,1% vs 37,6%; p=0,032) were more frequent in older patients. Despite re-hospitalizations were also more common (39,1% vs 30,6%), it didn’t reach statistical significance. After multivariate analysis, advanced age was not an independent predictor of mortality and/or re-hospitalization. In this population, only the presence of extracardiac arteriopathy (p=0,007) and a longer delay until surgery (p=0,05) were independent predictors of mortality. High Euroscore II values (p=0,031) were independent predictors of the composite of mortality or re-hospitalization.</p> <p><strong>Conclusion:</strong> Older patients have higher mortality, but advanced age was not an independent predictor of mortality and/or re-hospitalization. The decision to perform surgical aortic valve replacement in an octogenarian patient with symptomatic severe aortic stenosis should consider patient’s comorbidities, and not only the age per se.</p>
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