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.

[Results of Dor's endoventricular repair in the management of left ventricular aneurysms]. / Resultados da reparação endoventricular de Dor no tratamento cirurgico dos aneurismas do ventrículo esquerdo.

INTRODUCTION: Left ventricular aneurysms are serious long-term complications from acute myocardial infarction that produce hemodynamic alterations in the cardiac function. OBJECTIVE: The aim of this study is to evaluate the chirurgical and clinic results of the endoventricular patch repair of the akinetic or dyskinetic portions of the left ventricle. METHODS: From August 2002 to October 2005, 20 consecutive patients underwent surgical repair of left ventricular aneurysm using the endoventricular patch repair technique. The mean age was 63,6 years, and 80% where male. Every patient have had only one episode of acute myocardial infarction, which resulted in a akinetic or dyskinetic alteration in the motility of the left ventricle. The preoperative functional class of most of the patients was class III or IV and 45% where on angina class II. In 90% of the patients the ventricular aneurysm where antero-septal. Left ventricular dysfunction was present in 65%. RESULTS: All patients underwent the Dor procedure associated with coronary artery bypass grafting. There was no perioperative mortality. One patient died in the immediate postoperative period. Four patients needed inotropic support for more than 24h and intra-aortic balloon pumping was used postoperatively in two cases. Mean hospital stay was 8,6 days. At late follow-up the functional class was I in 20%, class II in 55% and class III in 10%. The angina class was I in 65% of the cases. CONCLUSIONS: The surgical repair of left ventricular aneurysm using the endoventricular patch repair technique proved to be safe, causing significant clinical improvement and an increase in the ejection fraction.