Aortic valve replacement in septuagenarians.

Abstract To evaluate the risk factors of aortic valve replacement (AVR) in the elderly, 35 patients over the age of 70 who had undergone this procedure were reviewed. Twenty-four patients had isolated AVR, three had double valve replacement, seven had a combined procedure of AVR and aortocoronary bypass, and one had AVR and open mitral commissurotomy. There were 27 elective and eight emergency operations. Nineteen patients were in the New York Heart Association (NYHA) Class III, and 16 patients were in NYHA Class IV preoperatively. Hospital mortality was 7.4% (two cases) in the elective group, and 337.5% (three cases) in the emergency group. The major risk factors were found to be the urgency of operation and left ventricular failure associated with severe pulmonary hypertension. There was no postoperative mortality among the seven patients who underwent the combined procedures of AVR and aortocoronary bypass. Follow-up of survivors revealed that 90% returned to NYHA Class I or II, and have an improved lifestyle. Our data suggest that elective AVR is a safe beneficial operation in septuagenarians. Emergency surgery and severe left ventricular failure contribute to high mortality; therefore, AVR should be performed in septuagenarians as early as indicated.