PREDICTIVE FACTORS OF OPERATIVE RISK IN T HE TREATMENT OF AORTIC-STENOSIS IN ELDERLY PATIENTS

Aortic stenosis, the most extensive form of valvular disease in elderl y subjects, has become very common because of demographic reasons in i ndustrialised countries. The operative risk in patients over 70 years of age is significantly higher. The progressive rise in age of patient s referred for surgery justifies this analysis of predictive factors o f operative mortality. Between 1976 and February 1993, out of 2871 aor tic valve replacements, 675 (278 men and 397 women) patients were over 75 years of age and were included in this study. The average age was 78,5 +/- 3 years. Associated pathology was present in 226 patients. A bioprosthesis was chosen in 632 cases (93,6 %). An associated surgical procedure was required in 133 cases. The operative mortality was 12,4 +/- 1,3 % (84 deaths). Longitudinal analysis was per-formed for 4 suc cessive periods to assess the outcome of the study population over the 17 years. A statistical study was made of 50 variables and multivaria te analysis showed age (p < 0,0001), left ventricular failure (p < 0,0 001), non sinus rhythm (p < 0,0005) and emergency procedures (p < 0,02 ) to be independant preoperative predictive factors of mortality. In o rder to reduce this fisk, the authors recommend early surgical referra l to avoid emergency procedures and cardiac failure, and increased eff orts of myocardial protection during cardiopulmonary bypass. Despite t he risk, surgery is the only radical treatment of aortic stenosis, inc luding elderly patients.