Related Experiment Videos
[Heart valvular disease in patients 70 years old and older]
H Kawano1, S Fukunaga, K Arinaga
1Second Department of Surgery, Kurume University School of Medicine, Japan.
Insights
Open heart surgery is safe for elderly patients over 70, with an 88.4% 10-year survival rate. Physiological age, not chronological age, determines surgical suitability for improved quality of life.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Context:
- Elderly patients (>70 years) often present with complex health conditions, posing challenges for cardiac surgical interventions.
- Evaluating the safety and efficacy of open-heart surgery in this demographic is crucial for clinical decision-making.
- Previous studies have shown variable outcomes for elderly patients undergoing cardiac procedures.
Purpose:
- To assess the safety and long-term outcomes of various open-heart surgical procedures in patients over 70 years old.
- To identify factors associated with early and late mortality in this patient cohort.
- To determine the significance of physiological versus chronological age in surgical indications for elderly cardiac patients.
Summary:
- A retrospective analysis of 69 patients over 70 undergoing cardiac surgery (AVR, MVR, MVP, DVR, aortic root replacement, PVL repair) between 1986-1996.
- The study reported a 7.2% operative/hospital mortality and a 10-year survival rate of 88.4%.
- Renal dysfunction and direct valve replacement (DVR) were identified as risk factors for early mortality.
Impact:
- This study demonstrates that open-heart surgery can be performed safely in elderly patients, challenging the notion that advanced age is an absolute contraindication.
- It highlights the importance of assessing physiological age over chronological age when considering surgical interventions.
- The findings support an aggressive surgical approach in elderly patients when an enhanced quality of life is anticipated, provided risks are carefully managed.
Abstract:
From June 1986 to December 1996, 69 patients older than 70 years old underwent AVR (29 cases), MVR (21 cases), MVP (5 cases), DVR (10 cases), aortic root replacement (3 cases), repair of PVL (1 case) in our hospital. There are five (7.2%) operative and hospital deaths. The survival rate was 88.4% at 10 year after surgery and three (4.7%) late deaths. The factors associated with early deaths were renal dysfunction and DVR. Our surgical results suggest that open heart surgery can be performed safely even elderly patients, in spite of their precarious physiologic homeostasis. Not the chronological age but the physiological age is important determinant for surgical indication. If quality of life (QOL) can be expected to be enhanced, we recommend an aggressive surgical approach.