Aortic valve replacement in patients over 80 years of age: a comparative standard for balloon valvuloplasty

Elderly patients who develop symptomatic aortic valvular malfunction have a grave prognosis. Until recently they have not been seriously considered for active treatment, such as valvular surgery or balloon valvuloplasty. Between January 1972 and July 1989, 88 patients over the age of 80 years underwent aortic valve replacement and have been prospectively followed for a total of 185 patient-years. The majority were in New York Heart Association functional class III (48%) or IV (48%) preoperatively. Valvular pathology was pure aortic stenosis in 81%, regurgitation alone in 6%, and mixed lesions in 13% of the cases. Before 1982 the majority of patients received mechanical valves, whereas tissue valves have predominated since then (76% of total). Forty-three percent of the patients had concomitant coronary artery bypass grafting. The overall operative mortality was 16%. Emergency surgery, isolated aortic valve replacement, advanced preoperative functional class, and female gender carried a statistically higher operative mortality. The overall actuarial survival (standard error) at 5 years was 64(7)%. Survival was significantly higher at 5 years for concomitant coronary bypass grafting than for isolated aortic valve replacement, 70 (11)% versus 59(8%), and for males compared to females, 73(9)% versus 55(9)%. The 5-year event-free rates for valve-related death and valve re-replacement were 97(2)% and 93(5)%, respectively. These data provide a firm basis for aortic valve replacement as the standard form of treatment in patients over 80.