Rapid Deployment Valves: Therapy of Choice in Elderly Patients?

Objective: Over the past few years the number of aortic valve replacements (AVR) has increased with outcomes that have been improved despite increasing age of patients and increasing burden of comorbidities. Rapid deployment (RD) AVR is an emerging alternative to standard AVR in elderly high-risk surgical patients. It has been even shown that for patients with severe aortic stenosis, RD-AVR may achieve better perioperative survival than TAVI.

Methods: 168 patients who received minimal invasive RDV (Edwards Intuity Elite, Edwards, USA) during 01/2014 and 08/2017 were included. 130 patients were younger than 80 years (YPG), 38 patients were older than 80 years (OPG). A retrospective analysis of intraoperative and early postoperative outcome was performed within both groups.

Results: Proportion of men and woman were equal in both groups (p = 0.07). EuroSCORE log. was significant higher in OPG than in YPG (13.6 ± 7.4; 7.5 ± 6.5 p = 0.000) and older patient were significantly more often operated as urgent cases as younger patients (OPG 31.6% YPG 16.9% p = 0.049). Intraoperative data showed no significant differences between both groups in Bypass (OPG 56.5 ± 30.3 minute YPG 61.08 ± 26.92 minute p = 0.09) - and X-clamp (OPG 42.9 ± 21 minute YPG 43 ± 17.5 minute p = 0.26) time. Valve size used was nearly equal in both groups (OPG 22.21 ± 2.4 mm YPG 22.66 ± 2.35 mm p = 0.3). None of the patients died at ICU. There were no differences in time spent at ICU between the groups (OPG 1.77 ± 2.6 days YPG 2.1 ± 3.7 days p = 0.42). Prevalence of postoperative AV-block was higher in OPG (OPG 13.2% YPG 5.4%) but not statistical significant (p = 0.1). There was no significant difference in postoperative DGS between both groups. In OPG 7.9% (YPG 3.1%) showed a fleeting and 5.3% (YPG 6.2%) a therapy-relevant DGS. None of the patients in OPG needed postoperative dialyses, as in YPG 10.7% needed postoperative dialyses (p = 0.46).

Conclusion: Even if there is a prognostic higher risk in older patients our data show that it is feasible to offer minimal invasive RVD operations to this group of patients. Minimal invasive RVD may reduce the risk of DGS in the elderly, and make the ICU outcome comparable to younger patients. Further studies matching comparable TAVI patients to minimal invasive RVD patients older than 80 are needed.