BMC Cardiovascular Disorders · Jul 30, 2026

Age matters? Investigating VARC-3 outcomes in surgical aortic valve reoperations: a multicenter study

By Pradegan N, Garufi L, Lena T et al.

BACKGROUND: Redo surgical aortic valve replacement (rSAVR) is known to carry higher operative risk compared with first-time aortic valve surgery. Evidence on how age influences outcomes following rSAVR remains scarce. This study aimed to evaluate clinical outcomes after rSAVR, with a focus on the role of age. METHODS: We retrospectively reviewed all adult patients who underwent rSAVR in four centers between January 2015 and December 2022. The primary endpoint was Valve Academic Research Consortium-3 (VARC-3) periprocedural mortality. The impact of age on survival was assessed using univariable Cox regression analysis. RESULTS: A total of 215 patients were included (63% male; median age 69 years, IQR 59-75). Previous biological prostheses were present in 165 cases (77%). The median EuroSCORE II was 4.8% (IQR 3.0-8.1). Indications for reoperation included structural valve deterioration in 100 patients (46%), endocarditis in 87 (40%), and paravalvular leak in 14 (7%). Concomitant procedures were performed in 96 patients (45%), and 39 (18%) underwent urgent surgery. A biological valve was implanted in 159 patients (74%). Periprocedural VARC-3 mortality occurred in 22 cases (10%). Age showed no significant effect on periprocedural mortality (OR 0.87, 95% CI 0.53-1.42, p = 0.42). During follow-up (median 4 years, IQR 2-5), overall survival was 86% (95% CI 81-91) at 1 year and 78% (95% CI 72-85) at 5 years. Age showed a significant non-linear association with late death at follow-up (p = 0.012), with a change-point at 70 years above which the risk increased progressively (HR 2.64, 95% CI 1.04-6.71 for an 85- vs. 70-year-old patient). CONCLUSIONS: In our multicenter experience, rSAVR remains associated with relevant periprocedural risk. Age does not influence early VARC-3 mortality, but patients aged 70 years or older, as expected, show increased long-term mortality.

doi.org/10.1186/s12872-026-06252-3Open accessPubMed 42934500Populations