title: Comparison of Preoperative and Postoperative Characteristics in Octogenarians Having Isolated Surgical Aortic Valve Replacement Before Versus After Introduction of Transcatheter Aortic Valve Implantation.
abstract: Aortic stenosis (AS) is the most frequent heart valve disease. Surgical aortic valve replacement (SAVR) is the reference treatment. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment. New strategies for treating the AS are upcoming. The aim of the study was to assess if the clinical profile of octogenarian patients treated surgically before and after the TAVI program initiation has changed. We retrospectively included consecutive octogenarian patients, who underwent isolated SAVR, from January 2006 to December 2011 in a single high-volume center. We compared preoperative and postoperative characteristics before and after the initiation of TAVI (February 2009). Five hundred seventeen patients were included: 229 in the "pre-TAVI" group (2006 to 2008), 288 in the "post-TAVI" group (2009 to 2011). The mean age was 83.2 ± 2.0 in the "pre-TAVI" group, 83.5 ± 2.1 in the "post-TAVI" group (p = 0.106). There were no significant differences in preoperative characteristics: New York Heart Association class (p = 0.374), history of heart failure (p = 0.680), left ventricular ejection fraction (59.8 ± 12.2% in the "pre-TAVI" group, 59.9 ± 11.3% in the "post-TAVI" group, p = 0.922), coronary artery disease (p = 0.431), chronic pulmonary disease (p = 0.363), and previous cardiac surgery (p = 0.085). The logistic EuroSCORE was 7.78 ± 4.60% in the "pre-TAVI" group and 7.33 ± 3.96% in the "post-TAVI" group (p = 0.236). The operative mortality (30-day) was comparable: 5.2% in the "pre-TAVI" group, 6.9% in the "post-TAVI" group (p = 0.424). Thus, with the emergence of TAVI, the number of octogenarian patients operated on, their preoperative characteristics, and the operative mortality remained comparable.
authors.affiliation: CHU Rennes, Service de cardiologie et maladies vasculaires, Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Moukda
authors.initials: M
authors.lastname: Khounlaboud
authors.affiliation: CHU Rennes, Service de cardiologie et maladies vasculaires, Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France. Electronic address: erwan.donal@chu-rennes.fr.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: CHU Rennes, Service de cardiologie et maladies vasculaires, Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Auffret
authors.affiliation: INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU Rennes, Service de Chirurgie cardiaque, thoracique et vasculaire, Rennes, France.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.affiliation: CHU Rennes, Service de Chirurgie cardiaque, thoracique et vasculaire, Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Ingels
authors.affiliation: INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU Rennes, Service de Chirurgie cardiaque, thoracique et vasculaire, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flécher
authors.affiliation: INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU Rennes, Service de Chirurgie cardiaque, thoracique et vasculaire, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: CHU Rennes, Service de cardiologie et maladies vasculaires, Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Daubert
authors.affiliation: CHU Rennes, Service de cardiologie et maladies vasculaires, Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
authors.affiliation: CHU Rennes, Service de cardiologie et maladies vasculaires, Rennes, France; INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: INSERM, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU Rennes, Service de Chirurgie cardiaque, thoracique et vasculaire, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality / Q000706:statistics & numerical data*