Yc. Hinojal et al., RESULTS OF AORTIC-VALVE REPLACEMENT SURGE RY IN THE POPULATION AGED OVER 75 YEARS, Revista Clinica Espanola, 198(5), 1998, pp. 289-293
The increase in the mean populational age has increased the number of
elderly people eligible for cardiac surgery. The aortic pathology repr
esents the most common valvular pathology, mainly of degenerative etio
logy. The efficiency of the aortic valve replacement in people aged ov
er 75 years was studied, with evaluation of hospital mortality, surviv
al and functional class (NYHA). Materials and methods. A total of 51 p
atients (25 males and 26 females, mean age 76.4 years [range: 75-83])
underwent aortic valve replacement from October 1989 to February 1997.
The most common condition was aortic stenosis (62.7%), followed by ao
rtic insufficiency (19%) and double aortic lesion (17%). Moreover, 31.
3% of patients required also coronary surgery with a mean of 1.1 graft
s per patient. In 13.7% of cases surgery on mitral valve was performed
(1 commissurotomy, 1 mitral prosthesis, 5 valve prostheses). In 10% o
f patients the procedure had to be performed on an emergency basis. Th
e functional class of patients prior to surgery was NYHA grade III for
37% and grade IV for 10% of cases. The clinical symptoms corresponded
to angor in 15 cases (29.4%) and syncope in four cases (7.8%). In nin
e patients the left ventricular ejection fraction Drier to surgery was
below 50%. Aortic bioprostheses were implanted in 86.2% of cases. Res
ults. The hospital fatality rate was 13.7% (7 cases). In the univariat
e analysis the following mortality risk factors reached statistical si
gnificance: left ventricular ejection fraction prior to surgery below
50%, associated surgery and size of aortic prosthesis. In the multivar
iate analysis the following risk factors were significant: left ventri
cular ejection fraction prior to surgery below 50% and associated mitr
al surgery. The follow-up was performed in 100% of patients, with a me
an time of 29.6 months. One patient died during follow-up. The functio
nal class was NYHA grade I in 95.2% of cases. The actuarial survival,
including hospital mortality, was 84.2% at 5 years. Conclusions. Despi
te a higher mortality in the aortic valve replacement surgery in patie
nts aged over 75 years compared with general population, results, long
-term survival and life quality of patients, renders surgery a non ref
usable first option as therapy for aortic valve pathology in this age
group. Nevertheless, avoiding the deterioration of preoperative left v
entricular function is imperative, mainly in those cases with concomit
ant mitral pathology, as both factors significantly contribute to an i
ncrease in mortality in this group.