Cardiac surgery in nonagenarians: Rethinking operative strategies in the era of TAVR and TMVR

Abstract

As growth of the elderly population continues to increase alongside improvements in percutaneous and minimally invasive interventions, cardiac surgeons question the role of high‐risk surgery in treating these patients. TAVR has transformed the management of symptomatic severe aortic stenosis in elderly patients and has become standard therapy for patients greater than 80 years of age. With improvements in procedural risks and technical complications for both transcatheter valves and percutaneous interventions, should we rethink the operative strategies for octogenarians and nonagenarians, particularly as they apply to concurrent high‐risk operations?

Cardiac Surgery in Nonagenarians Following the TAVI/TMVI Era: A Multicenter 23-Year Comparative Analysis

“…Regardless, the ambiguity in terms of the correct preoperative risk assessment remains, when considering all the possible alternative interventional procedures that could be performed [ 6 ]. Therefore, probing whether technical and technological advances and collective strategic choices have led to a possible improvement in the outcome of these patients is imperative [ 7 ]. Our primary objective, which began by collecting data on such patients from the end of the 1990s [ 2 ], is to precisely compare 90-year-old patients operated on in an era that we could define as “pre TAVI and TMVR”, which is not limited to patients exclusively suffering from valve pathology, to those who are now chosen to undergo cardiac surgery following collective analysis by a “heart team” that deems the suitability of an alternative strategy for individual patients.…”