AORTIC-VALVE REPLACEMENT FOR OCTOGENARIANS - ARE SMALL VALVES BAD

Background. As the population ages, more octogenarians become candidat es for aortic valve replacement. Many octogenarians, particularly wome n, have a small aortic annulus and there is uncertainty as to the opti mal management of this situation in that age group. Method. To examine this issue, we reviewed 248 octogenarians (mean age, 82.6 +/- 2.3 yea rs; 58% men) who underwent primary isolated aortic valve replacement ( n = 99), or aortic valve replacement and coronary revascularization (n = 149), between 1980 and 1995. Nineteen-millimeter valves were used i n 26% of the patients. Results. In-hospital mortality was 8.9%, 5% for aortic valve replacement alone and 11.4% for aortic valve replacement and coronary revascularization. It was 12.5% for the 19-mm size valve s compared with 7.7% for the bigger size valves (p = 0.24). Follow-up (mean interval, 4.4 years) demonstrated survival for all patients of 8 5%, 60%, and 30% and survival free from cardiovascular events of 80%, 45%, and 21% at 1, 5, and 10 postoperative years, respectively. Multiv ariate analysis identified triple-vessel disease and preoperative cong estive heart failure as associated with increased risk for both in-hos pital and late mortality (p < 0.05). Valve size did not influence late survival or event-free survival regardless of body surface area. Conc lusions. The use of small aortic valve prostheses in octogenarians doe s not adversely affect the incidence of early or late mortality or car diac events. (Ann Thorac Surg 1998;66:699-706) (C) 1998 by The Society of Thoracic Surgeons.