Risk Factors for Reduced Long-term Survival Following Isolated Surgical Aortic Valve Replacement in Different Age Groups.

Abstract

Background: According to recent guidelines, the selection of transcatheter vs. surgical aortic valve replacement (TAVR vs SAVR) in low-risk patients depends on age and life expectancy. Our objective was to understand independent risk factors for reduced life expectancy following isolated SAVR and the rate of re-do aortic valve (AV) intervention in different age groups, to delineate optimal intervention depending on patient characteristics.

Methods: Between 2000-2015, 2026 patients underwent isolated SAVR with Edwards pericardial tissue valves. Multivariable models were conducted to determine independent risk factors for long-term survival in three age groups.

Results: The 10-year survival rates were 83.4±2.3%, 72.7± 2.6% and 39.8±3.0% in Group I (age <65 years, n=577), II (age 65 - <75 years, n=693) and III (age ≥75 years, n=756), respectively. Independent factors for the reduced long-term survival were pulmonary hypertension (PH), renal failure, peripheral vascular disease, diabetes, and NYHA class IV in Group I; PH, diabetes, current smoking, and atrial arrhythmia in Group II; and PH, anemia, and NYHA class IV in Group III. The re-do AV intervention rate at 10 years was much higher in Group I than in Groups II and III (14.7±2.5% vs. 3.4±1.1% and 0.8±0.4%, P<0.001).

Conclusions: We identified risk factors for reduced long-term survival following isolated SAVR in different age groups and PH being the only risk factor across all ages, which should assist in decision-making for SAVR vs. TAVR. Our results also support the current recommendation of bioprostheses in patients aged >65 years given extremely low rate of re-do AV intervention.