Early and Late Outcomes after Multivalve Surgery in Octogenarians: A 23- Year Single-Center Experience

Abstract Background Multivalve surgery in octogenarians is poorly characterized; published series are small and report only early or one-year outcomes. We evaluated early and late outcomes over a 23-year period, compared with a non-octogenarian multivalve comparator from the same institution. Methods Retrospective review of a prospectively maintained institutional database (2000–2024). Patients aged 80 years or older undergoing surgery on two or more heart valves were compared with patients aged under 80. In-hospital mortality was the primary early endpoint; long-term survival was estimated by Kaplan-Meier analysis, censored 11 September 2024. Cox regression identified predictors of late mortality among octogenarians. Results 249 octogenarians (mean age 83.4 ± 2.5 years) underwent multivalve surgery, versus 1217 non-octogenarians. In-hospital mortality was 6.4% versus 5.0% (p = 0.45); octogenarian status was not independently associated with in-hospital mortality after adjustment for sex, concomitant bypass, and urgency (adjusted odds ratio 1.43, p = 0.23). One-year survival was similar between groups (88.4% vs 89.8%) but diverged progressively thereafter (63.8% vs 75.2% at 5 years; log-rank p < 0.001). Diabetes was the only independent predictor of late mortality (hazard ratio 1.83, 95% confidence interval 1.05–3.17, p = 0.033). Conclusions Multivalve surgery in carefully selected octogenarians carries early mortality comparable to younger multivalve surgery patients, with survival divergence emerging in the intermediate and long term rather than immediately. To our knowledge, this represents the largest reported series (249 patients) and longest follow-up (23 years) of multivalve surgery in octogenarians, and supports selective surgical referral guided by multidisciplinary assessment rather than age alone.