Introduction
Dr. Elsisy and colleagues present a comprehensive retrospective review of all patients (32,421) over a 26-year period at the Mayo clinic that underwent open heart surgery. They compared outcomes for nonagenarians and octogenarians, with a regression analysis to evaluate predictors of late mortality in nonagenarians. They determined that 0.4% (143) were nonagenarians and 12.6% (4077) of patients were octogenarians. Of nonagenarians, surgical operations were CABG at 15.7%, CABG-Valve at 39.6%, and isolated Valve at 44.8%. Operative mortality was similar between nonagenarians (6%) and octogenarians (4.6%) and hospital complications were comparable between the two groups. While this patient cohort is a highly selected population of nonagenarians and octogenarians with an overall preoperative STS predicted mortality of 1.6% and 1.9% respectively, their operative mortality of 6% is the lowest reported mortality for nonagenarians over the past two decades. As TAVR has emerged in the recent era between 2011 and 2019, the incidence of SAVR in the Mayo group of nonagenarians and octogenarians declined to 0.3%, with all of those SAVRs done in 2011. This brought operative mortality of SAVR down to 4% from 1993 to 2011, with comparable TAVR mortality of 1% from 2011 to 2019 in reported group. The STS-PROM risk scores underrepresented the 30-day mortality in nonagenarians in this patient cohort.1