Long-Term Survival among Octogenarians Undergoing Aortic Valve Replacement with or without Simultaneous Coronary Artery Bypass Grafting: A 22-Year Tertiary Single-Center Experience

Abstract

Background: The impact of concomitant coronary artery bypass grafting (CABG) on aortic valve replacement (AVR) in octogenarians is still debated. We analyzed the characteristics and long-term survival of octogenarians undergoing isolated AVR and AVR + CABG. Methods: All octogenarians who consecutively underwent AVR with or without concomitant CABG at our tertiary cardiac center between 2000 and 2022 were included. Patients with redo, emergent, or any other concomitant procedures were excluded. The primary endpoints were 30-day and long-term survival. The secondary endpoints were early postoperative outcomes and determinants of long-term survival. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality, and Cox regression analysis was performed for predictors of adverse long-term survival. Results: A total of 1011 patients who underwent AVR (83.0 [81.0–85.0] years, 42.0% males) and 1055 with AVR + CABG (83.0 [81.2–85.4] years, 66.1% males) were included in our study. Survival at 30 days and at 1, 3, and 5 years in the AVR group was 97.9%, 91.5%, 80.5%, and 66.2%, respectively, while in the AVR + CABG group it was 96.2%, 89.6%, 77.7%, and 64.7%, respectively. There was no significant difference in median postoperative survival between the AVR and AVR + CABG groups (7.1 years [IQR: 6.7–7.5] vs. 6.6 years [IQR: 6.3–7.2], respectively, p = 0.21). Significant predictors of adverse long-term survival in the AVR group included age (hazard ratio (HR): 1.09; 95% CI: 1.06–1.12, p < 0.001), previous MI (HR: 2.08; 95% CI: 1.32–3.28, p = 0.002), and chronic kidney disease (HR 2.07; 95% CI: 1.33–3.23, p = 0.001), while in the AVR + CABG group they included age (HR: 1.06; 95% CI: 1.04–1.10, p < 0.001) and diabetes mellitus (HR: 1.48; 95% CI: 1.15–1.89, p = 0.002). Concomitant CABG was not an independent risk factor for adverse long-term survival (HR: 0.89; 95% CI: 0.77–1.02, p = 0.09). Conclusions: The long-term survival of octogenarians who underwent AVR or AVR + CABG was similar and was not affected by adding concomitant CABG. However, octogenarians who underwent concomitant CABG with AVR had significantly higher in-hospital mortality. Each decision should be discussed within the heart team.

The Outcomes for Different Biological Heart Valve Prostheses in Surgical Aortic Valve Replacement before and after the Introduction of Transcatheter Aortic Valve Implantation

“…This increase was documented until 2016, noting that the inclusion of patients ended in June 2017. This observation is the continuation of an earlier and similar observation in our institution [10] and could also be observed in selected patients over 80 years old or patients with a prior malignancy [9,14,15]. Both patient groups could be good candidates for TAVI, because of a higher surgical risk or a lower life expectancy.…”

“…Although the numbers were relatively small, the conclusion was strengthened by propensity score match analysis [67]. These findings, as well as several recently published surgical series [2,14,15,[21][22][23][24][25]29,33,44,45], support our own finding that even in elderly and high-risk patients, SAVR can offer acceptable long-time survival, with potential consequent development of adverse events such as SVD. The surgical option still has a competitive value for the foreseeable future for both older and younger patients.…”