[Open-heart surgery in patients over 65 years of age. Lesions encountered and immediate postoperative mortality]

Open heart surgery after 65 is more and more frequent (16% of our surgical cases). Between January 1971 and December 1982, 8 425 open heart operations were performed in this Department, 1 377 of them in patients over 65. Most were cases of aortic valvulitis (620), and calcific aortic stenosis in particular, but also dystrophic aortic insufficiency; 217 patients underwent surgery for mitral valvulitis (rheumatic or dystrophic in origin) and 84 for involvement of more than one valve. Of the 2 440 patients with coronary lesions who underwent surgery, 255 were over 65; beyond this age, a higher rate of association between coronary lesions and valvular disease was found (167 patients undergoing surgery). Surgical mortality (during the first postoperative month) was higher after 65: 11.1% in patients with valve disease, and 11.4% in those with coronary artery disease, whereas in patients under 65 the figures were 6.5% and 4% respectively. On the other hand, in those undergoing surgery for combined valve and coronary disease, mortality over 65 was hardly any higher than under 65 (13.7% as against 10.4%). This justifies screening for coronary artery disease in any candidate for valve surgery aged over 65. These results were achieved thanks to some technical and anaesthetic precautions, and though they may be less satisfactory than those for younger patients, they justify such surgery for all lesions that threaten survival in the short term.