Aortic valve replacement in the octogenarians: perioperative outcome and clinical follow-up

Objectives: To determine long-term results of aortic valve replacement (AVR ) in patients 80 years old or older, and assess the factors influencing per ioperative outcome. Methods: Data were reviewed on 83 consecutive octogenar ians, undergoing aortic valve replacement between 1992 and 1997. There were 66 women and 17 men (mean age: 82.8 years). Fifty-seven patients (69%) wer e in New York Heart Association (NYHA) class III-IV and six had previous my ocardial infarction. Three patients had previous percutaneous aortic valvul oplasty. There were 19 urgent procedures (23%). Coronary artery bypass graf ting (CABG) was performed on 21 patients (25%). Possible influence of preop erative and operative variables on early and late mortality was performed w ith univariate and multivariate statistical analysis, and survival was esti mated with the Kaplan-Meier method. Results: Operative mortality was 13% (9 % for AVR, 24% for AVR-CABG). Postoperative complications were respiratory failure in 19 patients, atrial fibrillation in 19, hemodialysis in four, my ocardial infarction in four and stroke in two patients. Five patients requi red pacemaker insertion for permanent atrioventricular block. Median hospit al stay and intensive care unit stay were 19.8 +/- 12.2 days and 7.9 +/- 3. 4 days, respectively. Multivariate predictors of hospital death (P < 0.05) were percutaneous aortic valvuloplasty, NYHA class IV, and urgent procedure . Mean follow-up was 26.5 months. Survival at 1, 2, and 5 years was 98.5 +/ - 1.4% (63 patients at risk), 93.4 +/- 3.2% (47 patients at risk), and 78.2 +/- 6.9% (six patients at risk), respectively. Preoperative myocardial inf arction and urgent procedure were independent predictors of late death. At most recent follow-up, 91% were angina free and 81% were in class I-II. Con clusions: Aortic valve replacement in octogenarians can be performed with a cceptable mortality. These results stress the importance of early operation on elderly patients with aortic valve disease. Both long-term survival and functional recovery are excellent. (C) 1999 Elsevier Science B.V. All righ ts reserved.