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Valve replacement in the octogenarian.

A C Fiore1, K S Naunheim, H B Barner

  • 1Department of Surgery, St. Louis University Medical Center, Missouri.

The Annals of Thoracic Surgery
|July 1, 1989
PubMed
Summary
This summary is machine-generated.

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Elderly patients undergoing valve replacement surgery experienced significant mortality, especially with combined procedures. However, late clinical improvement justifies this approach for carefully selected individuals.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Elderly patients (80-88 years) often present with severe valve disease.
  • Surgical intervention in this demographic carries inherent risks.

Purpose of the Study:

  • To evaluate the outcomes of valve replacement surgery in elderly patients.
  • To compare the risks and benefits of isolated versus combined procedures.

Main Methods:

  • Retrospective analysis of 25 patients (mean age 82) undergoing valve replacement between 1980-1988.
  • Procedures included isolated valve replacement, valve replacement with myocardial revascularization, multiple valve procedures, and ascending aortic plication.
  • Patient functional class (New York Heart Association) and postoperative outcomes were assessed.

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Main Results:

  • Overall operative mortality was 20%, with late mortality at 20% (mean follow-up 36 months).
  • Isolated valve replacement had 9% early and 0% late mortality.
  • Combined procedures showed higher early (16%) and late (20%) mortality.
  • Only 28% of patients had uncomplicated postoperative hospitalizations.
  • Mean hospital stay was 18 days, with functional class improving to 1.6 +/- 0.66.

Conclusions:

  • Valve replacement in the elderly carries substantial operative and late mortality.
  • Combined procedures, particularly with myocardial revascularization or additional valve procedures, significantly increase operative risk.
  • Despite risks, late clinical improvement and return to independence justify valve replacement in select elderly patients.