[Severe symptomatic valve defects in elderly patients. Spontaneous prognosis and surgical results]

Between 1970 and 1982 125 patients aged, 65 to 79 years with severe symptomatic valvular heart disease. Aortic valve disease (72 with aortic stenosis) was encountered in 76 cases, mitral valve disease (22 with mitral regurgitation) in 32 and combined aortic and mitral lesions in 17. Additional severe coronary artery disease (narrowing greater than 70%) was present in 25% of the patients. 80% of the patients were in NYHA class III and IV, and 42% had experienced an episode of congestive heart failure. 28 patients did not undergo surgery; 10 died before surgery and 18 were not accepted or refused the operation. After 2 years only 1 of 18 patients with aortic stenosis was alive; in mitral valve disease 5 of 6 patients were alive. Among the 97 surgical patients, aortic valve replacement was performed in 58 cases, mitral valve surgery in 26 and combined aortic and mitral valve surgery in 13. Additional aorto-coronary bypass grafting was performed in 23 patients. Early mortality was 5% and 5-year survival rate 69%. NYHA class declined from 2.9 preoperatively to 1.6 postoperatively. In the elderly patient with severe symptomatic valvular heart disease surgery can be performed with acceptable operative risk and good late results. Surgical treatment is particularly indicated in aortic stenosis, due to the poor spontaneous prognosis. Coronary artery disease is frequent in this age group but is not a contraindication for surgery, in view of the good postoperative results of additional aorto-coronary bypass grafting.