Aortic valve replacement in patients aged over 70 years

During a 12-year period, 58 patients aged over 70 years underwent aortic valve replacement. Sixty-six % of them had pure stenosis, 24% were with combined aortic valve disease, and six patients had only regurgitation. Preoperatively, 81% were in NYHA III and the remaining in NYHA IV. The pressure gradient in the AS-group was 105 +/- 27 mmHg and in combined-group, 99 +/- 32 mmHg. The mean ejection fraction was 54 +/- 14%. Thirty-seven mechanical and 21 biological prostheses were placed. Concomitant procedures consisted of annular dilating plasty for five patients while 16 others had coronary by-pass grafting. Hospital mortality was 12%, with the leading causes being low output syndrome and infection complications. The causes of all late deaths were non-cardiac. During the follow-up period of 2.8 +/- 2.5 years, 74% of patients with mechanical valves and 62% of patients with bioprostheses were free from late complications. Prosthetic valve endocarditis (two patients) and valve failure (one patient) occurred only in patients with tissue valves. Embolic complications were equally distributed between the groups. All patients with mechanical valves were placed on permanent anticoagulation therapy, with two of them developing significant complications. On echocardiographic examination, moderate periprosthetic leakage was found in three patients, two of them having mechanical valves. There was a significant increase in EF and regression of left ventricular hypertrophy. At follow-up examination, all 47 living patients found their performance capacity improved.