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Valve surgery in patients over the age of sixty-five
Insights
Elderly patients undergoing valvular heart surgery have significant hospital and late mortality rates. Age alone is not a decisive factor, but mitral valve replacement (MVR) shows higher late mortality than aortic valve replacement (AVR).
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
Background:
- Valvular heart disease is prevalent in elderly populations.
- Surgical intervention is often considered for improving outcomes in this demographic.
Purpose of the Study:
- To evaluate the outcomes of valvular heart surgery in patients over 65.
- To compare mortality rates between isolated valve replacements and multiple procedures.
- To assess the impact of age and specific valve types on surgical outcomes.
Main Methods:
- Retrospective analysis of 201 patients aged over 65 undergoing valvular heart surgery.
- Categorization of procedures into isolated aortic valve replacement (AVR), isolated mitral valve replacement (MVR), and multiple procedures.
- Comparison of hospital and late mortality rates across different surgical groups.
Main Results:
- Overall hospital mortality was 5.5%, with late mortality at 18.4%.
- Isolated valve replacement had a hospital mortality of 1.5% (AVR 1%, MVR 2%), significantly lower than multiple procedures (16%).
- Late mortality was significantly higher after MVR (30%) compared to AVR (14.6%).
Conclusions:
- Age alone should not preclude elderly patients from valvular heart surgery.
- Mitral valve replacement carries a higher late mortality risk than aortic valve replacement in this population.
- Coronary artery disease may be a more significant risk factor with mitral valve disease than aortic valve disease.
Abstract:
Two hundred one patients over the age of 65 underwent valvular heart surgery with a hospital mortality of 5.5% and a late mortality of 18.4%. One hundred forty-one patients underwent isolated valve replacement (90 AVR, 51 MVR) with a hospital mortality of 1.5% (AVR 1%, MVR 2%). Multiple procedures carried a significantly higher hospital mortality (16%). Analysis of hospital and late deaths does not suggest that age alone should be accepted as a decisive factor in selection for surgery. There is a significantly higher late mortality in those who have had MVR (30%) compared with those having had AVR (14.6%). The importance of associated coronary artery disease as a risk factor has not been defined, but there is some evidence to suggest it is more important in this respect when found in association with mitral valve rather than aortic valve disease. An improved quality of life postoperatively was evident in the majority of survivors.