Advanced age per se should not be an exclusion criterion for minimally invasive aortic valve replacement.
OBJECTIVE
The introduction of transcatheter aortic valve implantation (TAVI), coupled with the increasing number of elderly patients requiring cardiac surgery, has given rise to an intense debate on the most appropriate treatment strategy for this high-risk population. The study aim was to compare clinical outcomes in older versus younger patients undergoing minimally invasive aortic valve replacement (AVR).


METHODS
Between March 2010 and July 2012, 66 patients undergoing minimally invasive isolated AVR with the sutureless Perceval S bioprosthesis (Sorin Group, Saluggia, Italy) were allocated to two groups according to age > or = 80 years (group A, n = 25) or < 80 years (group B, n = 41). In-hospital and follow up data were collected for all patients, including an evaluation of the patients' quality of life, using the SF-36 questionnaire.


RESULTS
Mean age and logistic EuroSCORE were statistically different between groups (p < 0.001 and p = 0.002, respectively). The length of intensive care unit stay was similar in groups A and B (1.9 +/- 0.8 and 2.5 +/- 1.4 days, respectively; p = 0.061). In-hospital mortality occurred in only one patient of group A (1.5%). Postoperative transient cerebral ischemic events occurred with similar frequency in both groups (two in group A and four in group B; p = 0.59). One patient in group A and two patients in group B required pacemaker implantation (1.5 versus 3%; p = 0.68). The mean follow up was 13.9 +/- 7.4 months, during which time three patients died (two in group A, one in group B). All enrolled patients answered the SF-36 questionnaire, and there were no significant differences between groups in all eight domains of the test.


CONCLUSIONS
Within the setting of minimally invasive isolated AVR, the study results showed that the clinical outcomes and quality of life in patients aged > or = 80 years were comparable to those of younger patients. Therefore, advanced age per se does not preclude successful AVR through a minimally invasive approach.
Department of Cardiac Surgery, Klinikum Nürnberg, Nuremberg, Germany. g.santarpino@libero.it
Giuseppe
G
Santarpino
Steffen
S
Pfeiffer
Ferdinand
F
Vogt
Martin
M
Hinzmann
Giovanni
G
Concistrè
Theodor
T
Fischlein
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data; D000075202:Contraindications; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011183:Postoperative Complications; D018570:Risk Assessment; D016896:Treatment Outcome