Valve Replacement for Calcified Aortic Stenosis in Septuagenarians Infers Normal Life-Length

Abstract

Aortic valve replacement because of pure or predominant stenosis was performed in 1970–1986 on 101 patients aged 70–78 years, including 80 in NYHA function class III or IV. There were 16 deaths within 30 days, and coronary artery disease (unby-passed in all but 1 case) was found in 11 of the 13 with autopsy or preoperative arteriography. None of the 12 patients without significant coronary artery disease at angiography died perioperatively, but one of 12 with combined valve replacement and coronary artery bypass grafting died. Cumulative 1-year survival among the 101 patients/the 85 survivors of the first 30 days and/a normal population matched for sex, age and year of operation was 75/90/96%. Corresponding percentages for 5 years were 64/75/77, for 10 years 43/52/52, and for 15 years 35/42/27. Advanced disease with kidney failure or left ventricular end-diastolic pressure >20 mmHg independently increased the overall mortality rate. The linearized rat of cerebral events (haemorrhage, embolism) was 2.7/100 patient years (age-specific background rate 1.6–1.9/100 patient years). The 30-day mortality among septuagenarians was reduced to 3% in 1988–1989 by routine revascularization in significant coronary artery disease. The patients who survived the first 30 days had normal life expectancy. Early operation may further improve the results.

Key Words:

• aortic valve stenosis
• heart valve replacement
• old age
• coronary artery disease