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Long term results of cardiac valve replacement in patients aged 75 years and older
1Department of Cardiovascular Surgery, Haut-Leveque's Cardiologique Hospital, Bordeaux, France.
Insights
Elderly patients over 75 undergoing valve replacement surgery showed a higher hospital mortality but similar long-term survival compared to younger patients. Bioprosthetic valves are recommended for this age group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Biomedical Engineering
Background:
- Elderly patients (over 75 years) present unique challenges for cardiac valve replacement.
- Previous data on surgical outcomes in this demographic is limited.
- Optimizing valve choice for longevity and safety is crucial.
Purpose of the Study:
- To evaluate the outcomes of valve replacement surgery in patients over 75 years of age.
- To compare the efficacy and safety of bioprosthetic versus mechanical valves in this population.
- To determine the long-term survival and functional status post-surgery.
Main Methods:
- Retrospective analysis of 158 patients (mean age 78) undergoing 164 valve replacements (aortic, mitral, double) between 1978 and 1989.
- Categorization of implanted valves into bioprostheses (66%) and mechanical prostheses (34%).
- Assessment of hospital mortality, late mortality, actuarial survival, and functional outcomes (NYHA class).
Main Results:
- Hospital mortality was 7%, with higher rates for associated procedures (9.8%), mitral (11%), and double valve replacements (16.6%).
- Late mortality was 13.6%, with 11-year actuarial survival at 71.5% +/- 5%.
- 95% of survivors achieved NYHA class I or II functional status; bioprosthetic structural deterioration was absent.
Conclusions:
- Despite higher initial mortality, valve replacement surgery is justified in patients over 75 due to significant functional improvement and comparable long-term survival.
- Bioprosthetic valves are suggested as the preferred option due to the absence of structural deterioration and lower risk of anticoagulant-related hemorrhages compared to mechanical valves.
Abstract:
From June 1978 to December 1989, 158 patients over 75 years of age (mean: 78 years; range 75 to 86 years) underwent 164 valve replacements: 134 in the aortic, 18 in the mitral and 6 in double mitral and aortic positions. One hundred and seven of these valves (66%) were bioprostheses, 93 aortic and 14 mitral and 57 valves (34%) were mechanical prostheses; 47 aortic and 10 mitral. Hospital mortality (less than or equal to 30 days) was 7% (11 patients, all in NYHA class III or IV) but was higher in patients who had undergone associated procedures (9.8%; 6/61 patients) or in patients who had mitral valve replacements (11%) and in double valve replacement (16.6%). Because of a minimal delay of one year, long term follow-up information (100%) was only obtained from the first 110 patients discharged from hospital. Late mortality has been 13.6% and actuarial survival at 11 years was 71.5% +/- 5. Therefore, despite a hospital mortality of more than twice that of patients operated upon under 75 years of age (3.3%), an actuarial survival at 11 years, similar to that of patients under 75 years (77 +/- 5%) and the functional improvement obtained (95% of survivors are NYHA class I or II) certainly justify surgery in these patients. Because of the incidence of anticoagulant related hemorrhages in these patients (1.7% patient year) and since, structural deterioration of the bioprostheses was non existent in this series, a bioprosthesis appears to be the best valvular substitute in patients over 75 years of age.