Early and long-term results of aortic valve replacement in patients aged 80 years and older

Background: Due to demographic changes in average life expectancy the age o f patients undergoing cardiac surgery is increasing as well. We have review ed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement with or without concomitant coronary grafting. Patients and Method: From 1. 1. 1995 until 31. 12. 1999, 126 patients (93 w omen, 33 men between 80 and 89 years, 82.8 +/- 2.4) underwent aortic valve replacement. 64 patients (group A) received isolated valve replacement, 62 (group B) underwent myocardial revascularization as well. Results: The 30-day hospital mortality rate was 6.3% for group A and 14.5% for group B. The follow-up time ranged between 3 and 63 months (32 +/- 16). None of the patients had to be reoperated for prosthetic va Ive dysfunctio n or endocarditis. Bleeding complications due to anticoagulation therapy we re observed by one patient from group A 3 years after the operation. Of the 15 deaths during the follow-up period seven (47%) were cardiac in nature a nd two (13%) related to stroke. Actuarial survival rates for group A were 8 9%, 85% and 77% at 1, 2 and 3 years, and for group B 76%, 72% and 70%. Perm anent nursing care was not required 1 year after the operation by 100% of p atients in group A (2 years: 98%, 3 years 95%) and by 100% of patients in g roup B (2 years: 93%, 3 yea rs: 90%) At an interval of 1 year after the ope ration 96% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 96%, 3 years: 94%) The rates for group B were 8 8%, 81% and 75%. Conclusion: Compared with younger age groups, aortic valve replacement in p atients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the po or prognosis of conservative therapy of symptomatic aortic valve disease, f unctional status as well as life expectancy in this age group seem to be po sitively influenced by aortic valve replacement.