Aortic valve replacement for severe aortic valve stenosis in the nonagenarian patient

Abstract

Background: Outcome data are limited on aortic valve replacement (AVR) in nonagenarian patients. This study reports our experience in the treatment of this elderly population.

Methods: A retrospective review was conducted of 59 patients 90 years of age or greater with severe aortic valve stenosis operated on with isolated AVR from January 1993 through August 2013. Valve replacement was surgical in 33 patients (55.9%) and transcatheter in 26 (44.1%).

Results: Median age of the patients was 91 years (range, 90 to 97 years), sex was female in 38 (64.4%), and The Society of Thoracic Surgeons predicted risk of mortality was 10.1% (range, 4.7% to 27.9%). Operative complications occurred in 22 patients (37.3%) and included acute renal failure in 7 patients (11.9%) and stroke in 1 patient (1.7%). Vascular injury occurred only in patients treated with transfemoral SAPIEN transcatheter heart valve transcatheter AVR and included 6 patients (42.9%). Discharge to home occurred in 17 patients (34.7%), with no difference between the valve replacement groups (p=0.072). Operative mortality occurred in 2 patients (6.1%) in the surgical AVR group and 1 (3.9%) in the transcatheter AVR group (p=1.000). Kaplan-Meier survival estimate at 1 year was 81.3%±5.4% with no difference between the valve replacement groups (p=0.636) and age- and sex-matched control patients (p=0.415).

Conclusions: Aortic valve replacement for severe aortic valve stenosis can be done with less than predicted operative risk in nonagenarian patients. However, transfemoral SAPIEN transcatheter heart valve transcatheter AVR should be undertaken with caution because of increased risk of vascular injury. Aortic valve replacement should not be denied in select patients.