SEVERE AORTIC-STENOSIS IN OCTOGENARIANS - IS OPERATION AN ACCEPTABLE ALTERNATIVE

From 1981 to 1989, 60 patients more than 80 years of age were referred for operation for severe calcific aortic stenosis. All patients were symptomatic: 13 in New York Heart Association (NYHA) functional class II, 28 in class III, and 19 in class IV. The preoperative mean cardiothoracic ratio was 0.58 ± 0.09; the mean valve area, 0.52 ± 0.14 cm2; and the mean aortic valve gradient, 62 ± 18 mm Hg. Left ventricular function was impaired in 30 patients (ejection fraction < 0.40). Coronary arteriography was performed in 10 patients. Aortic replacement used bio-prosthesis in all 60 patients associated with aortocoronary bypass (in 5) and mitral valve replacement (in 1). One-month mortality rate was 28% (17 patients) due to cardiac failure (in 9), pulmonary complications (in 6), and neurological complications (in 2). Early mortality was not correlated with preoperative angina, cardiothoracic ratio, associated operation, and cross-clamping time. It was not obviously correlated with preoperative functional class but correlated positively with urgent operations and with left ventricular function (40% mortality in patients with ejection fraction < 0.40 versus 16% mortality in others). Hospital morbidity was 68%. Mean hospitalization was 15 ± 7 days. There were four late deaths. Thirty-nine patients are long-term survivors (3 months to 7 years): 27 in class I, 10 in class II, and 2 in class III due to primary valve failure. The actuarial survival probability is 65% at 1 year and 61% at 5 years. In summary, the good long-term quality of life justifies the high postoperative risk in octogenarians. Early operation before cardiac function impairment improves the results. © 1990.