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[Cardiac valve replacement in the elderly]
1Department of Thoracic and Cardiovascular Surgery, Jichi Medical School.
Insights
Cardiac valve replacement in elderly patients over 60 shows acceptable mortality and excellent functional improvement. This study highlights successful outcomes for older adults undergoing heart valve surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Cardiac valve replacement is a common procedure.
- Elderly patients present unique challenges for cardiac surgery.
- Assessing outcomes in older adults is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the safety and efficacy of cardiac valve replacement in patients over 60 years of age.
- To compare outcomes in elderly patients with a younger cohort.
- To assess functional improvement and survival rates post-procedure.
Main Methods:
- Retrospective analysis of 71 elderly patients (>=60 years) and 231 younger patients undergoing cardiac valve replacement between 1980-1990.
- Detailed data collection on valve types (mechanical vs. bioprosthetic), concomitant procedures, preoperative functional status (NYHA Class), early mortality, and long-term survival.
- Follow-up period averaged 42 months.
Main Results:
- Elderly group: 11% early mortality, 88% 5-year and 74% 10-year actuarial survival. 85.7% achieved excellent functional improvement (NYHA Class I/II).
- Younger group: 3.0% early mortality, 95% 5-year and 86% 10-year actuarial survival. 91.3% achieved excellent functional improvement.
- Majority of elderly patients (88.7%) were NYHA Class III/IV preoperatively.
Conclusions:
- Cardiac valve replacement in elderly patients can be performed with acceptable early mortality.
- Significant and excellent functional improvement is achievable in older adults post-surgery.
- The findings support the consideration of cardiac valve replacement for selected elderly patients.
Abstract:
From January 1980 through December 1990, seventy one consecutive patients over 60 years of age (mean age 64 +/- 4 years) and 231 patients younger than 60 years underwent cardiac valve replacement procedures. In the elderly group, aortic valve replacement was performed in nineteen patients, mitral valve replacement in thirty-three patients both aortic and mitral valve replacement in sixteen patients, and both mitral and tricuspid valve replacement in three patients. Aortocoronary bypass was performed in four and tricuspid annuloplasty in 19 patients simultaneously. Two patients were operated on emergency. As for preoperative status, 63 patients (88.7%) were in New York Heart Association (NYHA) Functional Class III or IV. Mechanical valves were implanted in all aortic position and 16 mitral position. Bioprosthetic valves were placed in 34 mitral position and 3 tricuspid position. Mean follow-up period was 42 +/- 33 months. The early mortality rate was 11% (8 patients) and the actuarial survival rate was 88 +/- 5% at five years and 74 +/- 10% at ten years. Postoperative functional improvement was excellent in 85.7% of the survivors. In the younger age group, 77.9% belonged to NYHA class III or IV preoperatively. The early mortality was 3.0% (7 patients) and the actuarial survival rate was 95 +/- 2% at five years and 86 +/- 2% at ten years. And postoperatively 91.3% were in NYHA class I or II. In conclusion, cardiac valve replacement in the elderly can be performed with an acceptable mortality and excellent functional improvement.