Isolated aortic valve replacement in patients older than 65 years
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Aortic valve replacement in patients over 65 offers reasonable surgical risks and good recovery. Most survivors improved functional class, demonstrating the procedure
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Valvular Heart Disease
Background:
- Elderly patients often present with severe aortic stenosis and are at higher surgical risk.
- Optimizing outcomes for this demographic requires careful evaluation of risks and benefits.
Purpose of the Study:
- To analyze the outcomes of isolated aortic valve replacement in patients aged 65 years and older.
- To assess operative mortality, long-term survival, and functional status post-procedure.
Main Methods:
- Retrospective analysis of 196 patients undergoing isolated aortic valve replacement.
- Evaluation of preoperative New York Heart Association (NYHA) functional class.
- Assessment of operative mortality, causes of death, and long-term survival rates.
- Postoperative functional status and complication rates (e.g., stroke) were recorded.
Main Results:
- 84% of patients were NYHA class III or IV preoperatively.
- Overall operative mortality was 12% (9% for elective cases).
- Five-year survival was 55% overall and 61% for discharged patients.
- Myocardial and congestive heart failure were leading causes of death.
- 16% of discharged patients experienced embolic strokes, with 9% suffering substantial disability.
- 94% of survivors improved to NYHA class I or II.
Conclusions:
- Aortic valve replacement in elderly patients presents a manageable operative risk.
- The procedure leads to satisfactory functional rehabilitation in the majority of survivors.
- Careful patient selection and management are crucial for optimizing outcomes in this population.
Abstract:
The results of 196 isolated aortic valve replacements in patients older than 65 years were analyzed. Eighty-four percent of patients were in New York Heart Association (NYHA) functional class III or IV preoperatively. The operative mortality was 12% for all cases and 9% for elective cases. Actuarial probability of five-year survival was 55% for the entire group and 61% for discharged patients. Myocardial failure and congestive heart failure were the most common causes of early and late postoperative death, respectively. Embolic strokes occurred in 16% of discharged patients and caused substantial disability in 9%. At the termination of the study, 94% of surviving patients were in NYHA class I or II, and none were in class IV. Aortic valve replacement in elderly patients entails reasonable operative risk, and results in satisfactory postoperative rehabilitation.