PROGNOSIS AND QUALITY-OF-LIFE AFTER VALVE SURGERY IN PATIENTS OLDER THAN 75 YEARS

Background: Assessment of quality of life has become an increasingly i mportant aspect of the risk-benefit analysis of any therapeutic interv ention, particularly in high-risk populations, such as the elderly. Me thods: Clinical outcomes of 147 consecutive patients older than 75 yea rs undergoing valve surgery between 1992 and 1995 were reviewed. Long- term quality of life was assessed using a modified version of the Duke University Medical Outcomes Study system. Results: Mean age was 79.3/-4 years, range was 75 to 89 years, and 67% (99/147) were male. Preop eratively, 128 patients (87%) were in New York Heart Association (NYHA ) functional class III/IV, Fifty-two percent (77/147) of the operation s were nonelective. Concomitant coronary artery bypass grafting was pe rformed in 69 patients (47%). Thirty-day hospital mortality was 7.5% ( 11/147), Mean follow-up for 98% (133/136) of hospital survivors was 30 +/-13 months (range, 2 to 55 months), Actuarial survival at 55 months was 71+/-6%-equivalent to a general age-, race-, and gender-matched po pulation reported in the Life Tables of-the US National Center for Hea lth Statistics. At the time of follow-up, 112 patients (96%) lived at home, 78% (91/116) defined their health between good to excellent, and 81% (93/114) stated that the operation improved their health status, Ninety-seven percent (112/116) were able to bathe and dress independen tly, 92% (104/113) could walk at least one block, and 88.5% (100/113) could climb at least one flight of stairs, Moderate to vigorous activi ties could be performed by 59.2% (67/113), Overall, at tile time of fo llow-up, 81% (95/117) were in NYHA class I/II. Conclusion: In a select ed patient population, valve surgery in the elderly is associated with acceptable early morbidity and mortality, Long-term survival and qual ity of life are excellent, These facts strongly support the performanc e of these procedures in patients older than 75 years.