RESULTS OF AORTIC-VALVE REPLACEMENT SURGE RY IN THE POPULATION AGED OVER 75 YEARS

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.