Aortic Valve Replacement for Aortic Stenosis in Patients 70 Years and Older

(Department of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Japan)

Yasuyuki Kato Shigefumi Suehiro Toshihiko Shibata
Yasuyuki Sasaki Hidekazu Hirai Shigeru Sakamoto
Kenu Fumimoto Yasuyuki Bito Manabu Motoki
Yosuke Takahashi
We studied 73 patients, 70 years of age or older, who underwent aortic valve replacement for aortic stenosis between October, 1990 and October, 2004. There were 31 men and 42 women with a mean age of 75.7}3.6 years. Mechanical valves were implanted in 37 patients, and bioprostheses in 36 patients. Operative mortality was 1 of 73 (1.4%) and the New York Heart Association functional class improved to class I or class II in all of the hospital survivors. Follow-up (100%) extended from 0.3 to 11.6 yearsimean 3.7 years). There were 16 late deaths (5.9% per patient-year), including valve-related deaths in 6 patients. The overall survival rates at 5 and 10 years was 74.2% and 44.3%, respectively. The freedom from valve-related events at 5 and 10 years was 78.8% and 78.8%, respectively. The 10-year survival rates and freedom from valve-related events were not different between the patients with mechanical valves and those with bioprostheses. The size of the implanted valve did not influence the late survival or freedom from valve-related events. The outcome after aortic valve replacement in the elderly (70 years and older) was excellent with low operative mortality, and acceptable late mortality and morbidity. Thus, aortic valve replacement for elderly patients should have the same indications as for younger patients. Bioprostheses showed good long-term results with no structural valve deterioration, thromboembolism, or bleeding events. Mechanical valves, which required the maintenance of an anticoagulant therapy, were also useful with acceptable late morbidity. The long-term results with small valves (19mm) were comparable to the results with large valves (19mm) in the elderly. Thus, the use of these small valves in this particular age group seems to be acceptable.
@Jpn. J. Cardiovasc. Surg. 34: 389-394 (2005)