AORTIC-VALVE REPLACEMENT IN THE ELDERLY - RISK-FACTORS AND LONG-TERM RESULTS

Objective The current study was undertaken to determine long-ten resul ts of aortic valve replacement (AVR) in the elderly, to ascertain pred ictors of poor outcome, and to assess quality of life. Summary Backgro und Data Aortic valve replacement is the procedure of choice for elder ly patients with aortic valve disease. The number of patients aged 70 and older requiring AVR continues to increase. However, controversy ex ists as to whether surgery devoted to this subset reflect a cost-effec tive approach to attaining a meaningful quality of life. Methods This study reviews data on 247 patients aged 70 to 89 years who underwent i solated AVR between 1980 and 1995; there were 126 men (51%) and 121 wo men (49%). Follow-up was 97% complete (239/247 patients) for a total o f 974.9 patient-years. Mean age was 76.2 +/- 4.8 years. Operative mort ality and actuarial survival were determined. Patient age, gender, sym ptoms, associated diseases, prior conditions, New York Health Associat ion class congestive heart failure, native Valve disease, prosthetic v alve type, preoperative catheterization data, and early postoperative conditions were analyzed as possible predictors of outcome. Functional recovery was evaluated using the SF-36 quality assessment tool. Resul ts Operative mortality was 6.1% (15/247). Multivariate logistic regres sion showed that poor left ventricular function and preoperative pacem aker insertion were independent predictors of early mortality. After s urgery, infection was predictive of early mortality. Overall actuarial survival at 1, 5, and 10 years was 89.5 +/- 2% (198 patients at risk) , 69.3 +/- 3.4% (89 patients at risk), and 41.2 +/- 6% (13 patients at risk), respectively. Cox proportional hazards model showed that chron ic obstructive pulmonary disease and urgency of operation were indepen dent predictors of poor long-term survival. Postoperative renal failur e also was predictive of poor outcome. Using the SF-36 quality assessm ent tool, elderly patients who underwent AVR scored comparably to thei r age-matched population norms in seven of eight dimensions of overall health. The exception is mental health. Conclusions Aortic valve repl acement in the elderly can be performed with acceptable mortality. Sig nificant preoperative risk factors for early mortality include poor le ft ventricular function and preoperative pacemaker insertion. Predicto rs of late mortality include chronic obstructive pulmonary disease and urgency of operation. These results stress the importance of operatin g on the elderly with aortic valve disease; both long-term survival an d functional recovery are excellent.