SURGICAL-TREATMENT OF ACQUIRED VENTRICULAR SEPTAL-DEFECTS IN THE ELDERLY

Objective: As the population continues to age, older patients are bein g referred for repair of acquired ventricular septal defect (VSD) foll owing myocardial infraction (MI). The purpose of this study was to ass ess the effect of age (greater than or equal to 70 years) on operative risk and long term survival following repair of an acquired VSD. Meth ods: Between January 1972 and December 1995, 179 patients have undergo ne repair of acquired VSDs following MI in our unit. There were 118 ma les and 61 Females (age range 43-80 years) of whom 60 were aged 70 yea rs or above. Results: The overall early mortality was 27%. On univaria te analysis risk factors for early death included shorter time from bo th MI and detection of murmur to operation (P < 0.01, P = 0.04), site of MT (P < 0.01), higher NYHA class (P < 0.01), lower preoperative blo od pressure (P < 0.01) and longer cardiopulmonary bypass and cross cla mp times (P < 0.01, P = 0.03). Non significant variables included age, sex, concomitant CABG and preoperative renal function. Early mortalit y was 28.6% (34/119) in patients under 70 and 25.0% (15/60) in those o ver 70. This difference was not significant. The only significant diff erences between the age groups were sex distribution (females > males, P < O.O1), in the older group. and shorter time from both MI and dete ction of murmur to operation (P = 0.01, P = 0.02). Cardiopulmonary byp ass was the only statistically significant variable on multivariate an alysis (P = 0.O1). Conclusions: There was no significant difference in early mortality between the two age groups. As shorter times from bot h MI and detection of murmur to operation adversely affect early morta lity, age over 70 years should not be used to determine suitability fo r surgery. (C) 1997 Elsevier Science B.V.