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

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 redo aortic valve (AV) intervention in different age groups, to delineate optimal intervention depending on patient characteristics.

Methods

Between 2000 and 2015, 2026 patients underwent isolated SAVR with Carpentier-Edwards pericardial tissue valves (Edwards Lifesciences, Irvine, CA). Multivariable models were conducted to determine independent risk factors for long-term survival in 3 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 to < 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 New York Heart Association (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 redo 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 rates of redo AV intervention.