• Isaac George, Halit Yerebakan, Bindu Kalesan, Tamim Nazif, Susheel Kodali, Craig R Smith, and Mathew R Williams.
• Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY. Electronic address: ig2006@columbia.edu.
• J. Thorac. Cardiovasc. Surg.. 2014 Oct 1;148(4):1360-1369.e1.

ObjectivesAdvanced age plays a major role in surgical risk algorithms; however, the outcomes data for the very elderly are lacking. We, therefore, evaluated the outcomes after surgical aortic valve replacement (SAVR) in nonagenarians (age, >90 years) at our institution during an 11-year period.MethodsThe demographics, procedural details, and in-hospital outcomes were retrospectively analyzed for 119 nonagenarians with symptomatic, severe aortic stenosis who had undergone SAVR or SAVR plus concomitant surgery from 2001 to 2012. The mean follow-up period was 915±832 days.ResultsThe average age was 91.7±1.9 years (range, 90-98), and the mean Society of Thoracic Surgeons score was 8.9±5.7. The mean aortic valve gradient was 45±16 mm Hg, mean aortic valve area was 0.66±0.2 cm2, and mean ejection fraction was 49.8%±11.8%; 47% underwent isolated SAVR. The average length of stay was longer than expected; however, the rates of prolonged ventilation (16.8%), new atrial fibrillation (43.7%), stroke (0.8%), and renal failure (5.9%) were acceptable. Three patients (2.5%) required reoperation for bleeding. Overall, the 30-day and 1-year mortality was 7.6% and 21.0%, respectively. The multivariate predictors of mortality at 1 year included previous myocardial infarction (hazard ratio, 2.79; 95% confidence interval, 1.21-6.45; P=.016), obstructive lung disease (hazard ratio, 3.90; 95% confidence interval, 1.66-9.15; P=.025), and diabetes (hazard ratio, 2.77; 95% confidence interval, 1.08-7.07; P=.033). The observed in-hospital mortality was lower than expected (observed/expected, 0.85).ConclusionsExcellent procedural and long-term outcomes can be achieved in nonagenarians, and age alone should not be a contraindication to SAVR in selected populations. Our sample cohort has validated the feasibility of a primary operative strategy in elderly patients with aortic stenosis and acceptable risk profiles.Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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