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Valvular surgery in the elderly.

S E Fremes1, B S Goldman, J Ivanov

  • 1Division of Cardiovascular Surgery, University of Toronto, Canada.

Circulation
|September 1, 1989
PubMed
Summary
This summary is machine-generated.

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Elderly patients undergoing valvular surgery face higher operative mortality and morbidity. Risk factors like urgent surgery and left ventricular dysfunction independently predict death in older individuals.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Advanced age is a known predictor of operative mortality in valvular surgery.
  • Previous studies from this university identified age as a significant risk factor.

Purpose of the Study:

  • To compare early surgical results in patients over 70 years old versus those under 70.
  • To identify independent predictors of operative mortality in elderly patients undergoing valvular surgery.

Main Methods:

  • Prospective data collection of 31 clinical and angiographic variables.
  • Analysis of 469 patients >70 years old (Old) and 2,040 patients <70 years old (Young) between 1982-1986.
  • Univariate and multivariate statistical analysis, including stepwise logistic regression.

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Main Results:

  • Older patients had higher rates of left ventricular dysfunction, coronary artery disease, and urgent surgery.
  • Operative mortality (10.0% vs 5.6%) and major morbidity were significantly higher in the Old group.
  • Independent predictors of mortality in Old patients included urgent operation, mitral/double-valve surgery, coronary artery disease, female gender, and left ventricular dysfunction.

Conclusions:

  • Elderly patients undergoing valvular surgery have increased operative mortality and morbidity.
  • Risk stratification is crucial; surgical intervention is recommended for elderly patients in good risk categories.
  • Alternative therapies should be considered for elderly patients with multiple risk factors.