[Perioperative risk of valve replacement surgery in the elderly]

The indication of surgical valva replacement also at older age (greater than 60 years) with chronically rheumatic valvular diseases requires both the assessment of the pre-operative constellation of findings and perioperative complications. From this combined point of view statements concerning the strategy of valve replacement at older age seem to be concludable. In the frame of a prospective study perioperative parameters were monitored in n = 90 patients with preoperative high-risk constellation out of a total of n = 300 patients for the quick recording of additional complications (such as perioperative myocardial damage, cardiac low output syndrome, and cases of death at the ICU). The average age of the whole group of patients was 52 years (25-68 years), that of the patients greater than 60 years was 63.6 years (61-68 years). In 72% of the older patients the preoperative high-risk constellation was confirmed by 50% deceased; 16% cLOS; 6% perioperative myocardial damage (PMD). On a total of 41% of the patients a combined operation was performed (valve replacement and bypass operation), there of 2/3 with aortic valve replacement and 1/3 with mitral valve replacement. The ejection fraction restricted heavily already before the operation (less than or equal to 30%) was the essential cause of perioperative complications (cases of death, cLOS) together with the combined operation. The immedicable pulmonary hypertension complicated the already preoperatively impaired left-ventricular function in a high percentage of patients with mitral valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)