AORTIC-VALVE REPLACEMENT AT VERY OLD-AGE - GOOD SHORT-TERM AND LONG-TERM RESULTS

Background: The number of very old patients with symptomatic critical aortic stenosis is increasing. The decision to proceed with surgery is more complicated in these patients because the risk associated with s ymptomatic aortic stenosis has to be weighed against an increased peri operative risk and a smaller potential benefit in terms of life expect ancy. Methods: The present study determined hospital mortality and mor bidity as well as long-term follow-up after valve replacement for aort ic stenosis in 58 consecutive patients aged 75 years or more (mean+/-S D, 80+/-3.5 years). Results: Mean aortic valve area was 0.45+/-0.13 cm 2 and left ventricular ejection fraction was 59+/-12%. Bioprostheses w ere implanted in 38 patients and mechanical valves in 20 patients, wit h additional coronary artery bypass grafting in 10 patients. The mean hospital stay was 20+/-5 days, and no patients died prior to discharge . At a mean follow-up of 37+/-31 months, nine of 58 patients (16%) had died. This mortality rate was slightly lower than that of the age-mat ched general population. Actuarial survival was 97% at 1 year and 73% at 5 years. Among survivors, seven patients (14%) suffered late compli cations. Most patients (84%) improved by at least one functional class , and 85% were still living at home at the time of follow-up. Eighty-s ix percent would agree to undergo surgery again if necessary. Conclusi ons: Aortic valve replacement for aortic stenosis in very old patients is associated with marked functional improvement and with low mortali ty and morbidity during hospitalization and at long-term follow-up. Af ter this procedure, most patients are able to pursue an independent li fe at home.