[Valvular replacement for aortic stenosis in octogenarians. Apropos of a consecutive series of 200 cases]

From 1978 to 1992, 200 patients aged 80 to 90 (average 82.16 +/- 2.04 years) with calcific aortic stenosis, underwent isolated aortic valve replacement (187 cases, 93.5%), or associated with coronary bypass surgery (12 cases, 6%), or mitral valve replacement (MVR) (1 case, 0.5%), or surgery of the ascending aorta (4 cases, 2%). These 200 patients represented 7.4% of the 2,716 cases of aortic stenosis operated during the same period. One hundred and forty-eight patients (74%) were in NYHA classes III or IV. The operative mortality was 11.5% (23 patients) and the average hospital stay in the surgical department was 12.7 days (4.83%). The follow-up of the 177 patients who were discharged from hospital was complete (100%) with an average of 2.8 years +/- 2.1 (1 month to 10.6 years). Forty-nine secondary fatalities were observed (28%). Of the 128 survivors at the end of the study, 127 (98.6%) were in the NYHA classes I or II. The actuarial 1, 3 and 5 year survivals were 81.7, 74.8 and 57.1%, respectively. The survival curve of the operated patients was identical to subjects of the same age without aortic stenosis. Despite the high but acceptable operative risk due to the age, valvular replacement surgery is justified by the double benefit of increased longivity and improved quality of life.