Operation in the gray zone: is SAVR still useful in patients aged between 75 and 80 years?

Introduction: Aortic valve replacement is the only effective treatment for symptomatic aortic valve disease. Transcatheter implantation has been introduced as alternative for surgery (SAVR), but its penetration varied widely. For high-risk octogenarian patients, the advantages of TAVI are clear. Patients between 75 and 79 years of age could be considered as "the gray zone."

Methods: We compared the outcome of SAVR with or without concomitant procedures between patients younger than 75 versus 75-79 years for their preoperative profile, operative parameters, and postoperative outcomes.

Results: Older patients had a higher risk score with more cardiovascular comorbidity and renal dysfunction. They required more concomitant CABG but less mitral valve repair. Cardiopulmonary bypass time was similar. In-hospital complication rates, need for blood transfusion, and length of stay in intensive care unit were higher in older patients. Thirty-day mortality was not significantly increased, Euroscore II overestimated mortality in both age groups. Age over 75 years was not an independent predictor for mortality. Need for emergent SAVR was only predictive in the older group. Long-term survival was acceptable. Age over 75 years was not the dominant predictor.

Conclusions: SAVR remains a valid option to treat symptomatic aortic valve disease in the age group of 75-79.