The Annals of Thoracic Surgery · Sep 3, 2025

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

By Sawma T, Schaff HV, Arghami A et al.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

doi.org/10.1016/j.athoracsur.2025.08.028PubMed 40912622Populations