AGE EFFECT ON EARLY AND LATE VARC-3 OUTCOMES IN REDO AORTIC VALVE REPLACEMENT: A MULTICENTER STUDY

Background and Aim: Redo aortic valve replacement (re-AVR) is usually associated to increased operative mortality compared to primary aortic valve surgery. Limited data are available regarding the effect of age on outcomes after re-AVR. We aimed to analyze clinical outcomes after re-AVR with a focus on age effect. Materials and Methods: All adults who underwent re-AVR between January 2015-December 2022 at 4 Centers were retrospectively analyzed. Primary endpoints were VARC-3 periprocedural and >30-day death. Univariable Cox analysis was employed to assess the effect of age on survival outcome. Results: 215 patients (male 136 -63%-, median age 69, IQR 59-75) were included. Previous biological prostheses were used in 164 cases (76%). Median EuroSCORE II was 4.8% (IQR 3.0-8.1%). Causes of reintervention were: structural valve deterioration=100 (47%), endocarditis=87 (40%), paravalvular leak=14 (6%). Combined surgery (aortic valve + other) occurred in 99 patients (46%). Urgent operations occurred in 43 patients (20%). A biological prosthesis was implanted in 159 cases (74%). VARC-3 periprocedural death occurred in 22 cases (10%). Age did not affect VARC-3 periprocedural death (HR 0.87, CI 95% 0.53-1.42, p=0.42). At follow-up (median=4 years, IQR 2-5), overall survival was 81% (CI 75-86) and 77%(CI 71-84) at 3 and 5 years, respectively. Age at re-AVR>70-year was a risk factor for VARC-3 death>30 days (HR 2.64, CI 95% 1.04-6.71, p=0.0012). Conclusions: Re-AVR is associated to increased mortality. Age does not affect VARC-3 periprocedural death, but patients ≥70 years are at significantly increased risk of mortality>30 days. Age might become a selection criterium for reAVR.