April 21, 2026
As life expectancy continues to climb in the U.S., the number of octogenarians presenting for cardiac surgery also will increase. This includes patients who had previous cardiac surgery procedures, such as those with bioprosthetic valves that can deteriorate over time.
Anticipating the needs of these patients who are 80 and older, Mayo Clinic Cardiovascular Surgery specialists evaluated cardiac reoperation outcomes. The study, published in The Annals of Thoracic Surgery, shows the safety of valvular operations in octogenarians with prior sternotomy. The researchers evaluated long-term survival and self-reported quality of life.
The study consisted of 934 patients who underwent cardiac valve reoperations at Mayo Clinic from 2004 to 2023. The mean age was 83 years old and 29% of the patients were female.
Expanding surgical candidates
Outcome data on valvular surgery in octogenarian patients with a history of prior sternotomy are limited. Earlier research was scarce or derived from small sample sizes. Mayo Clinic Cardiovascular Surgery's vast expertise in performing complex cardiac surgeries makes this study distinctive.
"Patients live longer now than in the past and it is likely that they will outlive their previous biological valves or that they will live long enough to develop native valvular heart disease. Often these patients are not considered surgical candidates. Instead, they are sent for a transcatheter procedure," says Juan A. Crestanello, M.D., a cardiovascular surgeon and the chair of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Dr. Crestanello is senior author of the study.
"However, our paper shows that the surgical risk of valvular operations for patients age 80 and older with previous cardiac surgery is low. The operative mortality is 6%. The long-term survival is comparable to an age- and sex-matched U.S. general population," Dr. Crestanello says. "In addition, their functional status after surgery is excellent with almost 80% of the patients self-reporting good or excellent health status and high levels of physical activity at five years. Patients report significant improvement in their quality of life after surgery."
Balancing long-term benefits
Today, transcatheter interventions are often preferred in clinical practice for octogenarians because they minimize surgical trauma. Cardiac reoperations remain associated with increased morbidity and mortality. However, it's important to consider the advantages of performing cardiac reoperations in these patients, such as allowing correction of multiple pathologic processes simultaneously. Deciding to proceed with an invasive procedure in this high-risk population requires balancing early procedural risks and long-term benefits.
"The 30-day and one-year mortality rates in our series, particularly for aortic valve replacement, are better than the outcomes reported with transcatheter procedures in the TVT Registry," Dr. Crestanello says. "Similarly, we found less mitral regurgitation and lower one-year mortality when we compared mitral valve surgery with transcatheter edge-to-edge repair (TEER)."
Looking ahead
Treatment options are expanding for octogenarians with valvular disease. The long-term survival rates are excellent, as well as patients' improved quality of life after surgery. "Patients 80 and older should not be viewed as a contraindication to reoperative cardiac surgery, particularly when it's performed at a high-volume center with extensive surgical experience," Dr. Crestanello says. The study findings reflect appropriate patient selection, advancements in multidisciplinary management and perioperative care.
"Valvular surgery is an option for these patients with previous sternotomy. It should be performed in a center of excellence where patients are carefully evaluated, optimized and selected for surgery," Dr. Crestanello says. "Successful valve surgery can be performed in properly selected octogenarians even when they need concomitant procedures."
For more information
Sawma T, et al. Late survival and self-reported quality of life in octogenarians with prior sternotomy undergoing valvular surgery. The Annals of Thoracic Surgery. In press.
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