[Heart valve replacement in patients over 60]

Between 1976 and 1984, 182 patients over 60 years with valvular defects were examined invasively and valve replacement was performed. 34 patients (19%) were older than 70 years. Hospital mortality was 2% in aortic valve replacement, 4% in mitral valve and 8% in double valve replacement. Overall early mortality in patients between 60 and 70 years of age was 3.4% and 6% in patients over 70 years for all operations. Simultaneous aortocoronary bypass surgery did not enhance the operation risk. During the follow-up period of 23 +/- 22 months a total of 21 patients died (12%). Only 4% of the survivals showed clinical deterioration by at least one NYHA class. Clinical tendency to improvement was as clearly evident among the patients of over 70 years of age as among the entire group. Preoperative invasive and noninvasive data do not display any significant correlation with the result of surgery. Significantly higher (P less than 0.05) mortality rates or inferior functional operation results were seen only with higher age, a preceding valve operation, and preoperative NYHA class IV.

In elderly patients indication for valve replacement should not be more restrictive than in younger ones. Postponement of valve replacement in these age groups until the patient experiences symptoms when at rest (NYHA class IV) will adversely affect the chances of success and increase the mortality risk.