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Ann Thorac Surg 1990;50:226-229
© 1990 The Society of Thoracic Surgeons

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Articles

Severe aortic stenosis in octogenarians: Is operation an acceptable alternative?

Service de Chirurgie Thoracique et Cardiovasculaire, CHU. Henri Mondor, Créteil, France

Accepted for publication February 16, 1990.

^_* Address reprint requests to Dr Loisance, Centre de Recherches Chirurgicales, Faculté de Médicine, 8 rue du Général Sarrail, 94000 Créteil, France.

From 1981 to 1989, 60 patients more than 80 years of age were referred for operation for severe calcific aortic stenosis. All patients were symptomatic: 13 in New York Heart Association (NYHA) functional class II, 28 in class III, and 19 in class IV. The preoperative mean cardiothoracic ratio was 0.58 ± 0.09; the mean valve area, 0.52 ± 0.14 cm²; and the mean aortic valve gradient, 62 ± 18 mm Hg. Left ventricular function was impaired in 30 patients (ejection fraction < 0.40). Coronary arteriography was performed in 10 patients. Aortic replacement used bio-prosthesis in all 60 patients associated with aortocoronary bypass (in 5) and mitral valve replacement (in 1). One-month mortality rate was 28% (17 patients) due to cardiac failure (in 9), pulmonary complications (in 6), and neurological complications (in 2). Early mortality was not correlated with preoperative angina, cardiothoracic ratio, associated operation, and cross-clamping time. It was not obviously correlated with preoperative functional class but correlated positively with urgent operations and with left ventricular function (40% mortality in patients with ejection fraction < 0.40 versus 16% mortality in others). Hospital morbidity was 68%. Mean hospitalization was 15 ± 7 days. There were four late deaths. Thirty-nine patients are long-term survivors (3 months to 7 years): 27 in class I, 10 in class II, and 2 in class III due to primary valve failure. The actuarial survival probability is 65% at 1 year and 61% at 5 years. In summary, the good long-term quality of life justifies the high postoperative risk in octogenarians. Early operation before cardiac function impairment improves the results.

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