Aortic valve replacement in patients over 70 years.

Twenty-seven patients 70 years of age or more were operated upon with aortic valvular replacement with an early mortality rate of 7%. No more patients died during a mean follow-up period of 28 months. The Björk-Shiley standard tilting disc valve was implanted in 15 cases and the new convexo-concave model in 12 cases. Sixty-seven per cent of the patients had narrow aortic roots (21 and 23 mm prosthesis diameters) compared with 40% of younger patients. Thrombo-embolic complications occurred in 2 patients who had not received anticoagulant treatment. No such complications were recorded in the remaining 23 surviving patients treated with anticoagulants. All the surviving patients (except one who was re-operated because of a thrombotic encapsulation of the disc) were markedly improved postoperatively. High age alone is no longer an absolute contra-indication for aortic valve replacement. The convexo-concave Björk-Shiley tilting disc prosthesis is suitable in these patients because of its low resistance of flow at small diameters. The importance of anticoagulant treatment even in elderly patients is emphasized.