Age matters? Investigating VARC-3 outcomes in surgical aortic valve reoperations: a multicenter study
8 affiliations
- 1Cardiac Surgery Unit, Verona University Hospital, Piazzale Stefani 1, Verona, 37126 Italy
- 2PhD Program in Translational Specialistic Medicine “G.B. Morgagni”, Curriculum Cardiovascular Sciences, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- 3Cardiac Surgery Unit, San Camillo Hospital, Rome, Italy
- 4Cardiac Surgery Unit, Cardio-thoracic Vascular and Public Health Department, University of Padova, Padova, Italy
- 5Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
- 6Cardiac Surgery Unit, Ospedale dell’Angelo, Venice-Mestre, Italy
- 7Cardiac Surgery Unit, European Hospital of Rome, Rome, Italy
- 8Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Vascular Sciences and Public Health, University of Padova, Thoracic, Padova, Italy
Abstract
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.
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BibTeX
@article{pradegan2026matters,
title = {{Age matters? Investigating VARC-3 outcomes in surgical aortic valve reoperations: a multicenter study}},
author = {Nicola Pradegan and Luigi Garufi and Tea Lena and Mariangela Addonizio and Olimpia Bifulco and Lorenzo Longinotti and Marco Andreis and Marco Di Eusanio and Domenico Mangino and Ruggero De Paulis and Giulia Lorenzoni and Dario Gregori and Vincenzo Tarzia},
journal = {BMC Cardiovascular Disorders},
year = {2026},
month = jul,
doi = {10.1186/s12872-026-06252-3},
url = {https://doi.org/10.1186/s12872-026-06252-3},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Age matters? Investigating VARC-3 outcomes in surgical aortic valve reoperations: a multicenter study
AU - Nicola Pradegan
AU - Luigi Garufi
AU - Tea Lena
AU - Mariangela Addonizio
AU - Olimpia Bifulco
AU - Lorenzo Longinotti
AU - Marco Andreis
AU - Marco Di Eusanio
AU - Domenico Mangino
AU - Ruggero De Paulis
AU - Giulia Lorenzoni
AU - Dario Gregori
AU - Vincenzo Tarzia
PY - 2026
DA - 2026/07/30
JO - BMC Cardiovascular Disorders
DO - 10.1186/s12872-026-06252-3
UR - https://doi.org/10.1186/s12872-026-06252-3
AB - 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.
SN - 1471-2261
ER -