Objective : This study was undertaken to determine long-term results of aortic valve replacement (AVR) in patients 80 years old or older, and to assess factors influencing perioperative outcome.
Material and Methods : Data on 83 consecutive patients who underwent AVR between 1992 and 1997 were reviewed.
There were 66 women and 17 men; mean age was 82.8 years (range: 80-89 years).
Fifty-seven patients (69%) were in New York Heart Association (NYHA) class III-IV. Twentyone patients (25%) had concomitant coronary artery disease (CAD) and six had a history of myocardial infarction (MI). Three patients had previous percutaneous aortic valvuloplasty.
Indications for AVR were stenosis in 66 patients (79%) and combined stenosis and incompetence in 17 (21%). There were 19 urgent procedures (23%). Associated procedures included coronary artery bypass grafting (CABG) in 21 patients (25%), mitral valve repair in 2, and aortic annuloplasty in 2.
Results : In-hospital mortality was 13% (9% for AVR, 24% for AVR-CABG). Postoperative complications were pulmonary insufficiency in 25 patients (30%), atrial fibrillation in 19 (23%), renal insufficiency in 14 (17%), and stroke in 2. Five patients (6%) required pacemaker insertion for permanent atrioventricular bloc. Mean hospital stay and ICU stay were 19.8 and 7.9 days respectively. Multivariate predictors of hospital death (p < 0.05) were NYHA class, urgency of procedure, and preoperative MI. Mean follow-up was 26.5 months. Actuarial survival at 1 and 5 years was 98.5 ± 1.4 % and 78.2 ± 6.9 % respectively. Preoperative MI, preoperative pacing, and NYHA functional class IV were independent factors predicting late death. At most recent follow-up, 91% were angina free and 81% in class I-II. Ninety-two percent of patients believed having heart surgery after age 80 years was a good choice.
Conclusions: AVR in octogenarians is successful with acceptable mortality and prolonged hospital stay, mainly because of pulmonary complications. Long-term survival and quality of life are
good.