Valve replacement in aged patients. Risk and remote results

: A total of 102 patients aged 65 to 78 years underwent valvular replacement between 1975 and 1980. Calcific aortic stenosis was, by far, the commonest lesion (54 cases), followed by mitral stenosis (16 cases), mitral incompetence (14 cases), aortic incompetence (10 cases) and double valve lesions (8 cases). Sixty four patients underwent aortic valve replacement with 7 early deaths (10,9 p. 100). There were 30 mitral valve replacements with 7 deaths (23,3 p. 100) and 8 patients had double valve surgery with 4 deaths (50 p. 100). Aorto-coronary bypass grafting was associated in 25 cases with a 20 p. 100 mortality. Changes in the technique of peroperative myocardial protection have considerably reduced early mortality which has fallen from over 20 p. 100 to 2,9 p. 100 since the use of cardioplegia with local and systemic hypothermia. There was a higher surgical mortality in patients with poor left ventricular function, cardiomegaly and severe symptomatic incapacity. Non-fatal postoperative complications were common (50 p. 100 of survivors). There were 12 late deaths, 75 p. 100 of which were related to cardiovascular causes. The actuarial survival rate was 65,5 +/- 6 p. 100, 5 years after surgery. When operative mortality was excluded, the 5 year survival rate of the operated patients did not differ from that of the general populations of the same age (79,8 p. 100). Only 5 of our patients were lost to follow-up. Of the survivors, 95,5 p. 100 were asymptomatic or improved by at least one functional grade after an average postoperative period of 30 months. The incidence of late haemorrhagic complications in patients on anticoagulants was 11 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)