Outcomes of Surgical and Transcatheter Aortic Valve Replacement in the Octogenarians—Surgery Still the Gold Standard?

Wednesday, October 18, 2017

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Source

Source Name: Annals of Cardiothoracic Surgery

Source URL: http://www.annalscts.com/article/view/16207/html

Author(s)

Sameer A. Hirji, Fernando Ramirez-Del Val, Ahmed A. Kolkailah, Julius I. Ejiofor, Siobhan McGurk, Ritam Chowdhury, Jiyae Lee, Pinak B. Shah, Piotr S. Sobieszczyk, Sary F. Aranki, Marc P. Pelletier, Prem S. Shekar, Tsuyoshi Kaneko

This study evaluates 1028 octogenarians who underwent isolated aortic valve replacement (AVR, 306 TAVR and 722 SAVR) between 2002 and 2015 at Brigham and Women’s Hospital in the US. The mean age of patients was 84.4 ± 3.4 years old, with overall STS-PROM score of 5.96 ± 3.87. After adjusting for confounders, both of these elderly cohorts had similar operative mortality and short-term outcomes. No difference in mid-term survival was seen when comparing transfemoral TAVR, transsubclavian or transaortic TAVR, minimally invasive AVR, and sternotomy AVR. The authors suggest that these results indicate a continued role for SAVR in treating aortic stenosis in this patient population.

Comments

Submitted by Ghassan Musleh on Sun, 2017-10-22 15:11

It is nice to know from this non randomised trial that there is no difference in the midterm outcome of AVR regardless of the approach. It will be great to wait and see what will be the long term results of this cohort.

Submitted by Leo Fitzgibbon on Wed, 2017-11-01 21:31

with all due respect, in this cohort of octegenariens , do you really think that the timeline will extend far enough that you will see a difference. The answer is no. Therfore I would suggest we honor our oath "primum non nocere" or in English first do no harm, sincerely...