A contemporary evaluation of surgical aortic valve replacement outcomes and temporal trends

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Chang, Shantel
Yong, Matthew SS
Stroebel, Andrie
Hughes, Ian
Scuffham, Paul
He, Cheng
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2023
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Abstract

Background: Given the ageing population and uptake of transcatheter approaches for treating aortic stenosis (AS), a renewed evaluation of outcomes after surgical aortic valve replacement (SAVR) is warranted. With guidelines recommending age-based indications for surgical and transcatheter approaches, this study critically evaluates outcomes in age-based subgroups, with the aim to refine management of AS in the elderly, where there is often no clear consensus. Methods: Six hundred and thirteen consecutive patients who underwent SAVR in an Australian tertiary cardiac centre between 1 June 2014 and 13 January 2022 were retrospectively analysed. Of these, 70.31% were <75 years (Group 1) and 29.69% were ≥75 years (Group 2). Groups were compared with respect to early and long-term outcomes. Logistic regression, Kaplan–Meier survival estimates and Cox proportional hazards regression were performed for all patients and an AS-specific sub-group. Results: Patients aged ≥75 years were more likely to be female and have hypercholesterolemia, hypertension, and pre-existing arrhythmia (P < 0.001). Group 1 experienced a higher incidence of renal failure compared with Group 2, in the overall cohort and AS-specific subgroup (P = 0.02). The incidence of stroke was similar between groups, in the overall cohort (P = 0.22) and the AS-specific subgroup (P = 0.32). Age ≥ 75 was not found to be an independent predictor of 30-day, 1-year or 5-year mortality. Temporal trends revealed low consistently low complication rates. Conclusions: Elderly patients should not be denied surgery based on age, despite guideline-driven age-based recommendations.

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ANZ Journal of Surgery

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93

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6

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Subject

Clinical sciences

Dentistry

Science & Technology

Life Sciences & Biomedicine

Surgery

aortic stenosis

aortic valve

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Chang, S; Yong, MSS; Stroebel, A; Hughes, I; Scuffham, P; He, C, A contemporary evaluation of surgical aortic valve replacement outcomes and temporal trends, ANZ Journal of Surgery, 2023, 93 (6), pp. 1564-1570

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