Favorable outcome after composite valve-graft replacement in patients older than 65 years

Background. Concomitant surgical replacement of the aortic valve and ascend ing aorta is an ideal treatment for aortic root aneurysms, but there may be hesitation in its use in older patients, despite their known increased ris k of rupture. This study was conducted to examine our results in 84 patient s older than 65 years undergoing elective aortic root resection with compos ite valve-graft replacement. Methods. Eighty-four patients older than 65 years were operated on between June 1987 and August 1998. Median age was 74 years (range, 66 to 89 years), and 57 patients were men. Seventeen patients were undergoing reoperation. Aortic insufficiency was present in 70 patients. Forty-seven patients recei ved a conduit using a bioprosthesis, whereas in 37 a mechanical valved cond uit (St. Jude) was used. The ascending aorta alone was replaced in 23 patie nts; 50 had hemi-arch replacement, and in 11 the entire aortic arch was rep laced. Results. Hospital mortality was 8.3% (7 of 84). Sixteen late deaths (19%) w ere noted during a median follow-up of 3.2 years (range, 0 to 10 years). On ly one late death was aorta-related. The incidence of thrombotic or hemorrh agic complications was 2.1/100 patient-years, with equal frequency for both mechanical and bioprosthetic valves. Conclusions. We conclude that composite valve-graft replacement in elderly patients results in a low operative mortality, yields excellent long-term s urvival, and averts fatal aneurysm rupture in this high-risk population. (A nn Thorac Surg 2001;71:1454-9) (C) 2001 by The Society of Thoracic Surgeons .