VALVULAR REPLACEMENT FOR AORTIC-STENOSIS IN OCTOGENARIANS - RESULTS IN A SERIES OF 200 CONSECUTIVE PATIENTS

From 1978 to 1992, 200 patients aged 80 to 90 (average 82.16 +/- 2.04 years) with calcific aortic stenosis, underwent isolated aortic valve replacement (187 cases, 93.5 %), or associated with coronary bypass su rgery (12 cases, 6 %), or mitral valve replacement (MVR) (1 case, 0.5 %), or surgery of the ascending aorta (4 cases, 2 %). These 200 patien ts represented 7.4 % of the 2,716 cases of aortic stenosis operated du ring the same period. One hundred and forty-eight patients (74 %) were in NYHA classes III or IV. The operative mortality was 11.5 % (23 pat ients) and the average hospital stay in the surgical department was 12 .7 days (4.83 %). The follow-up of the 177 patients who were discharge d from hospital was complete (100 %) with an average of 2.8 years +/- 2.1 (1 month to 10.6 years). Forty-nine secondary fatalities were obse rved (28 %). Of the 128 survivors at the end of the study, 127 (98.6 % ) were in the NYHA classes I or II. The actuarial 1, 3 and 5 year surv ivals were 81.7, 74.8 and 57.1 %, respectively. The survival curve of the operated patients was identical to subjects of the same age withou t aortic stenosis. Despite the high but acceptable operative risk due to the age, valvular replacement surgery is justified by the double be nefit of increased longetivity and improved quality of life.