Complex Valve Surgery in Elderly Patients: Increasingly Necessary and Surprisingly Feasible

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Surgical Outcomes

Background:

• Elderly patients (75+) represent an increasing proportion of cardiac surgery candidates.
• These patients often have multiple comorbidities, increasing operative risk.
• Complex multiple valve surgery in this demographic presents unique clinical challenges.

Purpose of the Study:

• To review the outcomes of patients aged 75 and older undergoing complex multiple valve surgery.
• To assess the feasibility and safety of these procedures in an elderly population.
• To compare observed mortality with predicted risk.

Main Methods:

• Retrospective review of patients aged 75+ who underwent multiple valve surgery (Jan 2011-May 2016).
• Patients categorized into four subgroups based on valves operated: aortic/mitral (AM), aortic/tricuspid (AT), mitral/tricuspid (MT), and aortic/mitral/tricuspid (AMT).
• Analysis of perioperative mortality and major complications.

Main Results:

• 119 of 311 (38.3%) multiple valve surgery patients were 75 years or older.
• Observed 30-day mortality was 4.2%, lower than the predicted 10.7% (EuroSCORE II).
• Major complications included reexploration (16%), cerebrovascular events (6.7%), prolonged ventilation (10.1%), renal replacement therapy (15.1%), pneumonia (15.1%), and pacemaker implantation (18.5%).

Conclusions:

• Complex multiple valve surgery is feasible in elderly patients (75+).
• Perioperative mortality was lower than predicted, suggesting potential benefits.
• A substantial rate of adverse events necessitates careful patient selection for this high-risk group.