Late Survival and Self-Reported Quality of Life in Octogenarians With Prior Sternotomy Undergoing Valvular Surgery.

Abstract

Recent advances in transcatheter valve techniques often compete with open cardiac operations in managing high-risk patients with valvular disease, especially in the elderly. This study assessed late survival and quality of life after valvular surgery in octogenarians with prior sternotomy. We identified octogenarians who underwent cardiac valve reoperations between 2004 and 2023. Study end points were long-term mortality, long-term self-reported physical activity, and general health status. A total of 934 octogenarians (median age, 83 years; 29% women) had valve reoperations. Reoperations were isolated procedures in 72% (aortic [58%], mitral [10%], and tricuspid [4%]), multiple valve procedures in 16%, and valve + coronary artery bypass graft (CABG) in 12%. Previous operations were isolated CABG in 53%, isolated valve in 27%, valve + CABG in 17%, and others in 3%. Operative mortality was 6%. Total hospital stay was 6 days (4-9 days). Median survival was 5.6 years in this cohort compared with 5.9 years for a sex- and age-matched US population. At 1-, 3-, and 5-year follow-up, most survey respondents reported significant improvement in their general health status and physical activity levels. Renal failure (hazard ratio [HR], 2.1; P < .001), history of atrial fibrillation (HR, 1.2; P = .029), peripheral vascular disease (HR, 1.2; P = .026), cerebrovascular disease (HR, 1.2; P = .022), moderate or severe chronic lung disease (HR, 1.7; P < .001), and concomitant tricuspid valve surgery (HR, 1.5; P = .0022) were independently associated with increased late mortality. Repeated valve surgery in octogenarians can be performed with excellent short- and long-term outcomes. Age alone should not be a contraindication to reoperation for patients requiring intervention for valvular disease.