title: Aortic valve replacement in octogenarians with prior cardiac surgery.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has been advocated for very elderly patients with aortic stenosis, and prior cardiac surgery as a less invasive treatment option. Although surgical aortic valve replacement (AVR) is safe and effective in selected elderly patients, the perioperative and mid-term outcomes of AVR in very elderly with prior cardiac surgery are unknown.
  
  
  METHODS
  The Society of Thoracic Surgeons (STS) Database at our center enrolled 3,735 patients after AVR since 1997. In this time interval, we identified 61 patients 80 years and older who underwent AVR for severe AS or failed aortic bioprosthesis after having prior cardiac surgery. All clinical parameters were derived from the STS database. Follow-up mortality was assessed using the Social Security Death Index.
  
  
  RESULTS
  The average age of the patients was 83 ± 2 years, 77% were male, and 75% underwent an isolated coronary artery bypass graft (CABG) as their first cardiac procedure. The mean ejection fraction was 0.53 ± 0.13. The CABG was performed concurrently in 49% of patients at the time of redo sternotomy and AVR. Stented bioprosthesis was implanted in 61% of patients and stentless in 39%. Perioperative mortality was 1.6% (1 of 61). One, 3, 5, and 7 year survival rates were 85%, 69%, 63%, and 43%, respectively. Patients with AVR only had similar survival to patients who underwent concomitant AVR and CABG. Type of aortic prosthesis did not influence postoperative survival.
  
  
  CONCLUSIONS
  In selected patients over the age of 80 with history of prior cardiac surgery, AVR can be performed safely with very good mid-term outcomes. Age alone should not be exclusion criteria for surgical AVR in octogenarians with prior cardiac surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan. Electronic address: timek@wmcts.com.
authors.forename: Tomasz A
authors.initials: TA
authors.lastname: Timek
authors.affiliation: Michigan State University College of Human Medicine, Grand Rapids, Michigan.
authors.forename: Zaahir
authors.initials: Z
authors.lastname: Turfe
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hooker
authors.affiliation: Grand Rapids Education Partners, Grand Rapids, Michigan; Department of Surgery, Michigan State University, Grand Rapids, Michigan.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Willekes
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Murphy
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Bove
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: John C
authors.initials: JC
authors.lastname: Heiser
authors.affiliation: Department of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Patzelt
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors