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.

Mycotic Pseudoaneurysm of the Aortic Arch.

A 59 year-old male presents with fever and left parasternal pain. Past medical history included arterial hypertension, dyslipidemia, smoking, obesity. His clinical exam was unremarkable. Both C-reactive protein and leucocytes were elevated. Chest computed tomography (CT) demonstrated a 18mm saccular pseudoaneurysm of the aortic arch with extensive adjacent densification and adenopathy (Figure 1 and 2). Methicillin-sensible Staphylococcus aureus was isolated from blood cultures. A transesophageal echocardiogram excluded endocarditis. Control Angio-CT after seven days showed a contained rupture and increase in diameter of the pseudoaneurysm. He underwent emergent surgery with circulatory arrest and anterograde cerebral perfusion; extensive resection of the pseudoaneurysmal aorta was performed, with reconstruction of the aortic arch using autologous pericardium, without implantation of foreign or synthetic material (Figure 3 and 4). He completed 4 weeks of Flucloxacillin IV, having been discharged under oral antibiotics.