Related Experiment Videos
[A study of valve replacement in the elderly]
T Yamashiro1, K Kuge, T Tamiya
1Second Department of Surgery, Kochi Medical School, Japan.
Insights
Elderly patients (≥60 years) undergoing valve replacement showed a 7-year survival rate of 70%. Surgical intervention is recommended for elderly patients when medical therapy is ineffective, following careful evaluation.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Cardiac Valve Disease
Context:
- Elderly patients (≥60 years) often present with complex cardiac valve pathologies.
- Surgical intervention for cardiac valve disease in the elderly requires careful consideration of risks and benefits.
Purpose:
- To evaluate the outcomes of valve replacement surgery in elderly patients.
- To assess the survival rates and complications associated with cardiac valve surgery in this demographic.
Summary:
- 42 valve replacements were performed in 41 elderly patients (mean age 76.0 years) between 1982 and 1989.
- Operative mortality was 4.8%, with a 7-year actuarial survival rate of 70%.
- Common complications included AV conduction disturbances, thromboembolism (7%/patient-year), and prosthetic valve endocarditis (3%/patient-year).
Impact:
- The study suggests that surgical treatment for elderly patients with cardiac valve disease can be beneficial when medical management fails.
- Positive surgical outcomes support the consideration of valve replacement in carefully selected elderly individuals.
- Findings highlight the importance of evaluating senile weakness for personalized surgical decision-making in geriatric cardiac surgery.
Abstract:
From March 1982 to June 1989, 42 valve replacements were performed in 41 consecutive elderly patients (age 60 years and older, mean age 76.0 years). Main etiology of their diseases is calcific AS 7 (4: bicuspid valve), degenerative AR 4, rheumatic AS/AR 5, AAE 2, MR due to MVP or chordal rupture 13, rheumatic MS/MR 13. Operative methods are AVR 14, MVR 22, DVR 6. Cumulative follow-up was 99.2 patient-years (mean 30.5 months). Operative deaths were 2 cases (4.8%) due to left ventricular ruptures after MVR. There were 4 late deaths (9.5%). Actuarial survival rate at 7 years was an overall of 70 +/- 12%. Most common early postoperative complication was AV conduction disturbances. Continuous III degrees AV Block 1, transient III degrees AVB 3 and transient II degrees AVB 1 occurred in 7 calcified AS cases with calcific deposition to the attachment of anterior half of the noncoronary cusp. Valve related late complications were thromboembolism (7%/patient-year) and prosthetic valve endocarditis (3%/patient-year). Actuarial incidence of event free survival among hospital survivors at 7 years was 55 +/- 11%. It is our belief that surgical treatment for elders should be rather positively done when medical therapy has not met desired effects, under well evaluation of senile weakness for each case.