[Results of aortic valve replacement surgery in patients over 75 years of age].

UNLABELLED

The increase in the mean populational age has increased the number of elderly people eligible for cardiac surgery. The aortic pathology represents the most common valvular pathology, mainly of degenerative etiology. The efficiency of the aortic valve replacement in people aged over 75 years was studied, with evaluation of hospital mortality, survival and functional class (NYHA).

MATERIALS AND METHODS

A total of 51 patients (25 males and 26 females, mean age 76.4 years [range: 75-83]) underwent aortic valve replacement from October 1989 to February 1997. The most common condition was aortic stenosis (62.7%), followed by aortic insufficiency (19%) and double aortic lesion (17%). Moreover, 31.3% of patients required also coronary surgery with a mean of 1.1 grafts per patient. In 13.7% of cases surgery on mitral valve was performed (1 commissurotomy, 1 mitral prosthesis, 5 valve prostheses). In 10% of patients the procedure had to be performed on an emergency basis. The functional class of patients prior to surgery was NYHA grade III for 37% and grade IV for 10% of cases. The clinical symptoms corresponded to angor in 15 cases (29.4%) and syncope in four cases (7.8%). In nine patients the left ventricular ejection fraction prior to surgery was below 50%. Aortic bioprostheses were implanted in 86.2% of cases.

RESULTS

The hospital fatality rate was 13.7% (7 cases). In the univariate analysis the following mortality risk factors reached statistical significance: left ventricular ejection fraction prior to surgery below 50%, associated surgery and size of aortic prosthesis. In the multivariate analysis the following risk factors were significant: left ventricular ejection fraction prior to surgery below 50% and associated mitral surgery. The follow-up was performed in 100% of patients, with a mean time of 29.6 months. One patient died during follow-up. The functional class was NYHA grade I in 95.2% of cases. The actuarial survival, including hospital mortality, was 84.2% at 5 years.

CONCLUSIONS

Despite a higher mortality in the aortic valve replacement surgery in patients aged over 75 years compared with general population, results, long-term survival and life quality of patients, renders surgery a non refusable first option as therapy for aortic valve pathology in this age group. Nevertheless, avoiding the deterioration of preoperative left ventricular function is imperative, mainly in those cases with concomitant mitral pathology, as both factors significantly contribute to an increase in mortality in this group.