title: Prognosis and quality of life after valve surgery in patients older than 75 years.
abstract: BACKGROUND
  Assessment of quality of life has become an increasingly important aspect of the risk-benefit analysis of any therapeutic intervention, particularly in high-risk populations, such as the elderly.
  
  
  METHODS
  Clinical outcomes of 147 consecutive patients older than 75 years undergoing valve surgery between 1992 and 1995 were reviewed. Long-term quality of life was assessed using a modified version of the Duke University Medical Outcomes Study system.
  
  
  RESULTS
  Mean age was 79.3+/-4 years, range was 75 to 89 years, and 67% (99/147) were male. Preoperatively, 128 patients (87%) were in New York Heart Association (NYHA) functional class III/IV. Fifty-two percent (77/147) of the operations were nonelective. Concomitant coronary artery bypass grafting was performed in 69 patients (47%). Thirty-day hospital mortality was 7.5% (11/147). Mean follow-up for 98% (133/136) of hospital survivors was 30+/-13 months (range, 2 to 55 months). Actuarial survival at 55 months was 71+/-6%-equivalent to a general age-, race-, and gender-matched population reported in the Life Tables of the US National Center for Health Statistics. At the time of follow-up, 112 patients (96%) lived at home, 78% (91/116) defined their health between good to excellent, and 81% (93/114) stated that the operation improved their health status. Ninety-seven percent (112/116) were able to bathe and dress independently, 92% (104/113) could walk at least one block, and 88.5% (100/113) could climb at least one flight of stairs. Moderate to vigorous activities could be performed by 59.2% (67/113). Overall, at the time of follow-up, 81% (95/117) were in NYHA class I/II.
  
  
  CONCLUSIONS
  In a selected patient population, valve surgery in the elderly is associated with acceptable early morbidity and mortality. Long-term survival and quality of life are excellent. These facts strongly support the performance of these procedures in patients older than 75 years.
authors.affiliation: Department of Cardiothoracic Surgery, Boston Medical Center, MA 02118, USA. oshapira@acs.bu.edu
authors.forename: O M
authors.initials: OM
authors.lastname: Shapira
authors.forename: R M
authors.initials: RM
authors.lastname: Kelleher
authors.forename: J
authors.initials: J
authors.lastname: Zelingher
authors.forename: D
authors.initials: D
authors.lastname: Whalen
authors.forename: C
authors.initials: C
authors.lastname: Fitzgerald
authors.forename: G S
authors.initials: GS
authors.lastname: Aldea
authors.forename: R J
authors.initials: RJ
authors.lastname: Shemin
mesh_terms: D000203:Activities of Daily Living; D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001021:Aortic Valve / Q000601:surgery*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D012111:Residence Characteristics; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology