[A study of valve replacement in the elderly].
From March 1982 to June 1989, 42 valve replacements were performed in 41 consecutive elderly patients (age 60 years and older, mean age 76.0 years). Main etiology of their diseases is calcific AS 7 (4: bicuspid valve), degenerative AR 4, rheumatic AS/AR 5, AAE 2, MR due to MVP or chordal rupture 13, rheumatic MS/MR 13. Operative methods are AVR 14, MVR 22, DVR 6. Cumulative follow-up was 99.2 patient-years (mean 30.5 months). Operative deaths were 2 cases (4.8%) due to left ventricular ruptures after MVR. There were 4 late deaths (9.5%). Actuarial survival rate at 7 years was an overall of 70 +/- 12%. Most common early postoperative complication was AV conduction disturbances. Continuous III degrees AV Block 1, transient III degrees AVB 3 and transient II degrees AVB 1 occurred in 7 calcified AS cases with calcific deposition to the attachment of anterior half of the noncoronary cusp. Valve related late complications were thromboembolism (7%/patient-year) and prosthetic valve endocarditis (3%/patient-year). Actuarial incidence of event free survival among hospital survivors at 7 years was 55 +/- 11%. It is our belief that surgical treatment for elders should be rather positively done when medical therapy has not met desired effects, under well evaluation of senile weakness for each case.
Yamashiro
T
T
Second Department of Surgery, Kochi Medical School, Japan.
Kuge
K
K
Tamiya
T
T
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004696:Endocarditis / Q000209:etiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology