Valve-sparing root replacement: How old is too old?

Objective

Valve-sparing root replacement (VSRR) is associated with excellent short- and long-term outcomes. Although typically offered in young patients, VSRR is performed over a wide age range, including into the eighth decade of life. This study analyzed the influence of age and preoperative comorbidities on operative outcomes, reoperation, and survival following VSRR.

Methods

From 2004 to 2021, 780 patients underwent VSRR in an academic database. VSRR was performed using the David V reimplantation technique. A discriminating age cutoff for the effect of age on long-term survival was determined by Contal and O'Quigley methods and patients were divided into 2 groups based on age at time of surgery.

Results

The optimal age cutoff for patients undergoing VSRR was found to be 65 years; 16% were aged 65 years or older at time of surgery. Overall, in-hospital mortality was 1.5% and was significantly higher among the group of patients older than age 65 years (4.1% vs 1.1%; P = .03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between the group of patients aged 65 years and older and patients younger than age 65 years (5% vs 6%; P = .28). Overall, 10-year survival was 89% and significantly worse among the patients aged 65 years and older (76% vs 92%; P < .0001). Age 65 years and older was an independent risk factor for late mortality (hazard ratio, 1.04; 95% CI, 1.01-1.07; P = .003).

Conclusions

VSRR can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients aged 65 years and older, serious consideration should be given when deciding on VSRR, especially in the setting of aortic dissection.