Octogenarians with aortic stenosis. Outcome after aortic valve replacement

To assess the outcome of aortic valve replacement for aortic stenosis in octogenarians, we retrospectively studied 64 patients, aged 80-89 years, who underwent aortic valve replacement for aortic stenosis from 1974 to 1987. Mean aortic valve gradient was 61 +/- 22 mm Hg, and valve area was 0.5 +/- 0.2 cm2. Concurrent coronary artery bypass grafting was performed in 29 patients, mitral valve replacement in two, and both procedures in two. Serious, comorbid, noncardiac conditions were infrequent. In-hospital mortality was 9.4%. Outcomes were classified as 1a) uncomplicated; 1b) complicated (technically complicated surgery, temporary encephalopathy, discharge to a rehabilitation facility, or some combination thereof) but with ultimately good results; or 2) unfavorable (death or permanent, severe neurological deficit). There were 28 (44%) patients in group 1a, 24 (38%) in group 1b, and 12 (19%) in group 2. Of 18 patients with preoperative left ventricular ejection fraction less than 50%, two (11%) were in group 2. Of 31 patients undergoing aortic valve replacement only, two (6%) were in group 2, compared with 10 of 33 (30%) patients who had concomitant coronary artery bypass grafting, mitral valve replacement, or both (p = 0.02). Late follow-up at 28 +/- 5 months revealed four cardiac and seven noncardiac deaths, with actuarial 1- and 5-year survival rates of 83 +/- 5% and 67 +/- 10%, respectively. With few exceptions, survivors were free of cardiac symptoms. Thus, short- and long-term outcomes after aortic valve replacement for aortic stenosis in otherwise healthy octogenarians is generally favorable, even in the presence of preoperative left ventricular systolic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)