title: Outcome of redo surgical aortic valve replacement in patients 80 years and older: results from the Multicenter RECORD Initiative.
abstract: BACKGROUND
  Octogenarians undergoing surgical aortic valve replacement (AVR) after prior cardiac surgery are expected to be at high risk of adverse events. This finding has recently popularized transcatheter AVR in this cohort.
  
  
  METHODS
  This multicenter study includes 744 patients (99 were 80 years or older) who underwent surgical AVR after prior cardiac surgery. The outcome of octogenarians was compared with younger patients in the entire cohort and in a propensity score-matched population.
  
  
  RESULTS
  Octogenarians and younger patients had similar immediate outcome (in-hospital mortality, 3.0% versus 5.9%; p=0.34; stroke, 5.1% versus 6.7%; p=0.66; dialysis, 9.1% versus 6.5%; p=0.34), as confirmed also in 84 propensity score-matched pairs. Octogenarians and younger patients had similar late survival (5-year survival, 83.1% versus 78.0%; p=0.68; propensity score-adjusted relative risk [RR], 0.23; 95% confidence interval [CI], 0.59 to 1.88). Octogenarians and younger patients had similar freedom from heart failure episodes (at 5 years, 84.5% versus 89.2%; p=0.311; propensity score-adjusted RR, 1.37; 95% CI, 0.62 to 3.04) and from reoperation (at 5 years, 94.9% versus 97.9%; p=0.51; propensity score-adjusted RR, 1.93; 95% CI, 0.35 to 10.56). However, octogenarians had poorer freedom from late stroke (at 5 years, 89.8% versus 97.5%; p=0.016; propensity score-adjusted RR, 6.137; 95% CI, 1.776 to 21.208) and peripheral thromboembolism (at 5 years, 90.0% versus 98.2%; p=0.003; propensity score-adjusted RR, 4.00; 95% CI, 1.07 to 15.00).
  
  
  CONCLUSIONS
  Octogenarians undergoing surgical AVR after prior cardiac surgery have similar immediate postoperative outcome as younger patients, and their 5-year outcome is excellent. These data suggest that indications to undergo transcatheter AVR should not rely only on coexistence of advanced age and history of prior cardiac surgery.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. Electronic address: frankono@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiac Surgery, University of Oulu, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.affiliation: Cardiac Surgery Unit, Varese University Hospital, Varese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Cardiac Surgery Unit, San Martino University Hospital, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: Cardiac Surgery Unit, Varese University Hospital, Varese, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Beghi
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy.
authors.forename: Giannantonio
authors.initials: G
authors.lastname: Nappi
authors.affiliation: Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.affiliation: Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.affiliation: Cardiac Surgery Unit, San Martino University Hospital, Genoa, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Passerone
authors.affiliation: Division of Cardiac Surgery, University of Oulu, Oulu, Finland.
authors.forename: Jeuni
authors.initials: J
authors.lastname: Heikkinen
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: 35