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Ann Thorac Surg 1984;38:466-472
© 1984 The Society of Thoracic Surgeons

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Articles

Should Valve Replacement and Related Procedures Be Performed in Elderly Patients?

United Hospitals, Inc., St. Paul, and Minneapolis Heart Institute, Minneapolis, MN.

¹ Address reprint requests to Dr. Arom, Minneapolis Heart Institute, 2545 Chicago Ave, Minneapolis, MN 55404.

The cases of 135 consecutive elderly patients 70 years old or older who had valve replacement and related surgical procedures from October, 1977, through April, 1982, were reviewed. There were 75 men and 60 women. The mean left ventricular ejection fraction was 50.16 ± 5%. The overall operative mortality was 8% (11 patients). The early operative deaths were related mainly to cardiac failure, low cardiac output, sepsis, and renal and multiorgan failure. To assess the operative risk, these 135 patients were compared with 312 younger patients (less than 70 years old) who had undergone similar procedures during the same period. The operative mortality in this group was 5.2% (16).

In-hospital complications included arrhythmia (13%), psychosis (7.4%), respiratory failure (6.7%), renal failure (6.7%), cerebrovascular accident (5.2%), myocardial infarction (4.4%), and reoperation for bleeding (2.2%). Wound dehiscence occurred in 1.5% of the patients, and pulmonary emboli and sepsis developed in 0.7%. Of these complications, only the incidence of cerebrovascular accident appeared to be more common in the elderly group (5.2% versus 2.8%), but it had no statistical significance (p = 0.18).

A follow-up of 3,892 patient-months was completed in 98.4% of the survivors. There were 8 late deaths (6.4%). Six were related to the valve or to ongoing cardiovascular disease. Thirty-four patients subsequently required medical attention: 4 had bleeding because of the anticoagulant; 3 required a blood transfusion; and 27 were hospitalized. Six were admitted for related cardiac conditions and 7, for observation of other conditions; 14 underwent surgical procedures not related to the cardiovascular system. All of the survivors had substantially improved their life-style and New York Heart Association Functional Class. They were active and able to participate in daily life.

Valve replacement and necessary related procedures can be accomplished in elderly patients with an acceptable operative mortality. Medium-term follow-up of these patients showed functional improvement and low mortality.

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