Age Is Not Just A Number For A Rapid Deployment Valve In Octogenarians.

INTRODUCTION: Aortic valve stenosis (AS) is the most common valvular pathology in the elderly and surgery (AVR) remains the gold-standard. However, transcatheter aortic valve replacement (TAVI) has become an emerging alternative to surgery. In a recent survey from the European Society of Cardiology, 9,4% stated that age was the main reason to propose for TAVI. METHODS: Single-center retrospective study including 353 patients (149 ≥80 years-old;204 with 60-69 years-old) submitted to AVR between 2013-2016. Primary endpoint was survival. Secondary outcomes included the rate of post- -operative complications. Long-term survival was determined by Kaplan-Meier survival analysis. Continuous variables were analyzed with t-test and linear regression and categorical variables with chi-square or Fisher. RESULTS: clinical characteristics were similar between the two groups. Both had similar survival at 30 days, 12 (93,29% 60-69yo vs 91,47% ≥80yo) and 24 months (88,34% 60-69yo vs 86,11% ≥80yo). However, rapid deployment valves (RD) had better survival rates in elderly patients. Cross-clamp time was lower in ≥80yo group, with higher percentage of RD valves (20,1% vs 4.9% in 60-69yo). The rate of post-operative atrial fibrillation was higher in >80yo group (29,06% vs. 17,28%,p=0,0147). In all patients, cross-clamp time was directly related to ventilation time(p=0,025) and chest drainage(p=0,0015). CONCLUSION: AVR after 80yo is safe. Cross-clamp time is directly correlated with ventilation time and bleeding, with a stronger correlation in patients over 80yo. RD valves reduce cross-clamp times, so their use in elderly may improve surgery outcome. Prospective studies are needed to evaluate if age may be clinical criteria for a RD.

Left Partial Anomalous Pulmonary Venous Return and Mitral Stenosis in an Adult.

Partial anomalous pulmonary venous return (PAPVR) is a relatively common congenital cardiac malformation in which one to three pulmonary veins drain to a systemic vein, the right atrium or the coronary sinus, resulting in a left-to-right shunt and the risk of developing pulmonary hypertension (PHT). It is frequently associated to other congenital cardiac defects (mainly atrial septal defect) but seldom associated with acquired cardiac disease, and normally involves the right lung. When it involves the left lung, the surgical correction in children is normally performed without prosthetic material. The authors report a case of associated mitral stenosis and left PAPVR corrected with comissurotomy and extra-anatomic derivation with a synthetic vascular graft.

Surgical aortic valve replacement in octogenarians: Single-center perioperative outcomes and five-year survival.

INTRODUCTION AND OBJECTIVES: Aortic stenosis is the most common valvular heart disease. The number of octogenarians proposed for intervention is growing due to increased lifespan. In this manuscript we aim to evaluate perioperative outcome and long-term survival after surgical aortic valve replacement (SAVR) in octogenarians, comparing patients with low surgical risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). METHODS: A retrospective observational single-center cohort study with 195 patients aged ≥80 years old, who underwent SAVR between 2017 and 2021, was conducted. Patients were divided into two groups according to EuroscoreII: (1) Low risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). Continuous variables are presented in median (IQR), analyzed using Wilcoxon rank sum test; categorical variables in percentages, analyzed using chi-squared test; and survival was analyzed by Kaplan-Meier, open cohort, and the log-rank test was performed. RESULTS: The overall median age was 82 (IQR 81-83), with 4.6% of the patients ≥85 years old. 23.6% of the patients presented EuroscoreII ≥4%. No complications were observed in 26.2%, with a significantly higher rate in intermediate-high risk patients. Postoperative need for hemodynamic support was the most frequent complication, followed by postoperative acute kidney injury and the use of blood products. Overall median ICU stay was three days (2-4) and hospital length of stay (LOS) six days (5-8). Patients with intermediate-high risk and those with complications had longer ICU LOS. At 12 months, overall survival was 96.4%, at three years 94.1% and 5 years 75.4%. Patients with low surgical risk had higher survival proportions up to 5 years. CONCLUSION: SAVR in patients ≥80 years is associated with low in-hospital mortality, although a significant proportion of patients develop complications. Long-term follow-up up to five years after surgery is acceptable in octogenarians with low surgical risk.

Ascending Aorta Sacular Aneurysm.

. A 83 year old woman with history of arterial hypertension, hypothyroidism, obesity, chronic renal insufficiency and incipient dementia was transferred to our hospital after complaints of chest pain. Investigation revealed a sacular ascending aortic aneurysm with the aneurysmal sac adjacent to the sternum. Due to her age, cognitive state and risk of sternal entry, she was refused for surgery. She was discharged after coronariography showed normal coronaries and other causes of chest pain were excluded. She is still alive and stable after 40 months, with no growth of aneurysm dimensions.

Surgical, anesthesical and perfusion strategies for open thoracoabdominal aneurysm repair.

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