Quality of life after aortic valve replacement at the age of > 80 years

Background-The optimal management of aortic valve disease in patients >80 y ears old depends on functional outcome as well as operative risks and late survival. Methods and Results-We retrospectively identified 133 patients (62 men, 71 women) aged 80 to 91 years (mean 84+/-3 years) who underwent aortic valve r eplacement alone or in combination with another procedure between January 1 , 1993, and April 31, 1998. Demographics included hypertension 68%, diabete s mellitus 17%, and history of stroke 11%. Operative (30 day) mortality rat e was 11%. Urgent or emergent surgery, aortic insufficiency, and perioperat ive stroke or renal dysfunction were risk factors for operative death by mu ltivariable analysis. Intensive care unit and total hospital length of stay were prolonged at 6.2 and 14.7 days, respectively. Late follow-up between July 1, 1998, and November 1, 1999, was 98% complete. Actuarial survival at 1 and 5 years was 80% and 55%, respectively. Predictors of late mortality were preoperative or perioperative stroke, chronic obstructive pulmonary di sease, aortic stenosis, and postoperative renal dysfunction. The mean New Y ork Heart Association functional class for 65 long-term survivors improved from 3.1 to 1.7. Quality of life assessed with the Medical Outcomes Study S hort Form-36 was comparable to that predicted for the general population >7 5 years old. Conclusions-Functional outcome after aortic valve replacement in patients > 80 years old is excellent, the operative risk is acceptable, and the late s urvival rate is good. Surgery should not be withheld from the elderly on th e basis of age alone.