Valve replacement

Aortic valve replacement in elderly patients

During the years 1965--75, 98 patients more than 65 years of age had aortic valve replacement in our hospital, 24 ball valves and 74 disc valves inserted in their aortic orifice. Actuarial analysis of survival in these patients shows that the operative risk is slightly higher in elder than in younger patients. The survival curve for the following years for those who had disc valve implantation runs parallel to that of younger patients, while those who had ball valve implantation showed a more rapid fall in survival after 3 years. After 10 years, only 30% of patients with ball valve transplantation were alive.

Cardiac valve replacement in elderly patients

Cardiac valve replacement in 65 consecutive elderly patients (aged 65 years and older) revealed that the indications for cardiac valve replacement in the elderly should be the same as those in the general population. These 65 patients represented 16% of the patients undergoing valve replacement. The mortality in the first 30 days after operation was 4.6% in the elderly group, compared with 0.9% in the group under 65 years of age. There were 26 significant but nonfatal early complications in the elderly patients, but their long-term functional status was excellent, most of the survivors ending up in either class I or class II of the New York Heart Association functional classification. The late mortality was 3.9% per patient year for aortic valve replacement and 15.1% for mitral with or without aortic valve replacement. The actuarial survival rates were 88% at 24 months and 55% at 54 months for the total elderly group, 86% at 36 months for those with aortic valve replacement, 85% at 24 months and 64% at 36 months for those with mitral valve replacement, 90% at 24 months and 77% at 42 months for the men, and 82% at 24 months and 68% at 42 months for the women. Aortic valve replacement was more common in the elderly than in the younger group because of the higher prevalence of congenital calcific aortic stenosis in the former, and this operation provided more gratifying results than mitral valve replacement in the elderly patients.