Repeat Aortic Valve Replacement Safe at 80+
Surgical aortic valve replacement generally improves patients' symptoms and prolongs survival. However, the perceived risk of surgical aortic valve replacement in patients over 80 may result in surgery being denied or a recommendation for alternative therapy. Investigators at the Mayo Clinic challenge the way these patients have been managed. They report that repeat sternotomy in patients over 80 who have previously had coronary bypass graft surgery can be done with low risk. Their findings are published in the March 2014 issue of Journal of Thoracic and Cardiovascular Surgery, an official publication of the American Association for Thoracic Surgery.
A release from the association quotes says lead investigator Kevin L. Greason, MD, Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, as saying, "Our experience is that the prevalence of operative morbidity and mortality is the same as for primary sternotomy and surgical aortic valve replacement. Based on the available evidence, there is no compelling argument to abandon the technique in favor of transcatheter replacement. Repeat sternotomy for surgical aortic valve replacement is a safe option."
The outcome of non-surgical management in elderly patients with symptomatic severe aortic valve stenosis is disappointing. A prior study demonstrated that nearly half of patients in their 80s who were treated with aggressive medical therapy died within a year. There is general agreement that such patients benefit from surgical aortic valve replacement. Earlier studies have shown that this appears to be as safe as transcatheter replacement and that there was no difference in 30-day operative mortality rates in patients who received transcatheter replacement versus surgical replacement. But little is known about the potential risks of repeat surgery.
To assess these risks, investigators reviewed the records of 629 octogenarian patients who had narrowing of the aortic valve in the heart and who had undergone sternotomy between January 1993 and December 2011. Of these, 111 patients (17.6%) had received a previous coronary artery bypass graft and therefore a repeat sternotomy was required. All patients had their surgery at the Mayo Clinic.