[Morbidity and mortality in patients aged over 75 years undergoing surgery for aortic valve replacement].
BACKGROUND
The greater longevity observed today has caused an increase in the number of elderly who need surgery. Aortic stenosis is a common condition in this age group.


OBJECTIVE
To evaluate morbidity and mortality in people aged 75 years or older who have undergone valvuloplasty or valve replacement surgery for aortic stenosis alone or associated with other injuries.


METHODS
We studied 230 consecutive cases between Jan/2002-Dec/2007. Patients were 79.5 +/- 3.7 years (75 - 94), and 53.9% were men. In the sample, 68.7% had hypertension, 17.9% had atrial fibrillation, 15.9% were obese, and 14.4% had undergone previous heart surgery. At surgery, 87.4% underwent aortic stent placement, and 12.6% underwent aortic valvuloplasty.


RESULTS
The mortality rate was 13.9% (9.4% with isolated aortic stenosis versus 20.9% with an associated procedure, p = 0.023) and the morbidity rate was 30.0% (25.2% with aortic stenosis alone versus 37.4% with an associated procedure, p = 0.068). The most common complications were: low cardiac output (20.2%), renal dysfunction (9.7%), and prolonged ventilatory support (7.9%). In the bivariate analysis, the main predictors of mortality were low cardiac output (RR 10.1, 95% CI: 5.02-20.3), use of intra-aortic balloon (RR 6.6, 95% CI: 3.83-11.4), sepsis (RR 6.77, 95%: 1.66-9.48) and renal dysfunction after surgery (RR 6.21, 95%: 3.47-11.1). As for morbidity, the predictors were: pre-operative renal dysfunction (RR 2.22, 95%: 1.25-3.95), atrial fibrillation (RR 1.74, 95%: 1.16-2.61), and chronic obstructive pulmonary disease (COPD) (RR 1.93, 95%: 1.25-2.97).


CONCLUSIONS
Aortic valve surgery in the elderly is related to a slightly higher mortality rate than in younger patients, and its main risk factors were associated procedures, renal failure, atrial fibrillation, COPD, and sepsis.
Valle
Felipe H
FH
Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil.
Costa
Altamiro R
AR
Pereira
Edemar M C
EM
Santos
Eduardo Z
EZ
Pivatto Júnior
Fernando
F
Bender
Luciano P
LP
Trombka
Marcelo
M
Modkovski
Thaís B
TB
Nesralla
Ivo A
IA
Kalil
Renato A K
RA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D058385:Cardiac Valve Annuloplasty / Q000401:mortality*; D002404:Catheterization / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome