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The Annals of Thoracic Surgery, Vol 50, 226-229, Copyright © 1990 by The Society of Thoracic Surgeons
P Deleuze, DY Loisance, F Besnainou, ML Hillion, P Aubry, G Bloch and JP Cachera
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 less than 0.40). Coronary
arteriography was performed in 10 patients. Aortic replacement used
bioprosthesis 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 less than 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.
ARTICLES
Severe aortic stenosis in octogenarians: is operation an acceptable alternative?
Service de Chirurgie Thoracique et Cardiovasculaire, CHU. Henri Mondor, Creteil, France.
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M. Kirsch, L. Guesnier, P. LeBesnerais, M.-L. Hillion, M. Debauchez, J. Seguin, and D. Y. Loisance Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy Ann. Thorac. Surg., July 1, 1998; 66(1): 60 - 67. [Abstract] [Full Text] [PDF]
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 J. B. Wong, D. N. Salem, and S. G. Pauker You're Never Too Old N. Engl. J. Med., April 1, 1993; 328(13): 971 - 975. [Full Text]
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