SURGERY FOR AORTIC-STENOSIS IN ELDERLY PATIENTS - A STUDY OF SURGICALRISK AND PREDICTIVE FACTORS

Background Aortic stenosis is the most common valvular lesion occurrin g among elderly patients and has become extremely frequent because of changing demographics in industrialized countries. Surgical risk after the age of 70 has increased. The increasing older age of patients hav ing surgery justifies an analysis of mortality predictive factors. Met hods and Results Between 1976 and February 1993, we performed 2871 ope rations for aortic stenosis. This study concerns 675 patients (278 men and 397 women) who were greater than or equal to 75 years old. Mean a ge was 78.5+/-3 years. Associated lesions were found in 226 patients. A bioprosthesis was implanted in 632 patients (93.6%). Concomitant sur gical procedures were performed in 133 patients. Surgical mortality wa s 12.4% (84 deaths). A longitudinal analysis has been carried out over four successive time periods to evaluate population evolution during these 17 years. Statistical analysis was performed on 46 variables. Mu ltivariate analysis found age (P<.0001), left ventricular failure (P<. 0001), lack of sinus rhythm (P<.01), and emergency status (P<.02) to b e presurgical independent predictive factors of mortality. Conclusions Risk-reducing strategy should both favor relatively early surgery to avoid cardiac failure and emergency situations and pay careful attenti on to the use of myocardial protection and cardiopulmonary bypass. Ind ications for surgery should remain broad since analysis failed to dete rmine specific high-risk groups to be eliminated, and surgery remains the only treatment for aortic stenosis.