RESUMO
ObjectiveTo evaluate the outcomes for elderly( ＞70 years) patients undergoing valvular heart surgery and determine the early mortality and major morbidity associated with cardiac valve surgery in the elderly.MethodsBetween 2005and 2011,1366 patients underwent cardiac valve surgery in our department.115 patients(65 males,50 females) were 70 or older [aged (74.3 ± 3.1 ) years].Rheumatic valvular disease presented in 68 ( 59.1％ ),degenerative valvular disease in 33(28.7 ％),congenital heart disease in 6 (5.2 ％) and the others in 8 (7.0％).20 cases( 17.4％ ) had hypertention,17 cases( 15.8 ％ ) had diabetes mellitus,18 (15.7％) had coronary heart disease.Chronic obstructive pulmonary disease was found in 25 cases(21.7 ％ ),and renal insufficiency was found in 9(7.8 ％ ).6 patients(5.2％ ) had the history of cerebrovascular disease.72 (62.6 ％) had atral fibrillation and 11 cases(9.6％ ) had the history of cardiac valve surgery previously.75(65.2 ％ ) cases were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ.Left ventricular ejection fraction (LVEF) was 0.28-0.72 (0.53 ± 0.01 ).All the patients receieved coronary angiography preoperatively.All the operations were performed on cardiac-pulmonary bypass (CPB) with moderate hypothermia.During CPB,the perfusional pressure was maintained between 60-70 mm Hg and the oxygen saturation for mixed venous blood was kept above 0.70.Artificial ultrafilitration was performed for all the patients during the time of CPB.55 ( 47.8 ％ ) patients had mitral valve replacement ( MVR),3 (2.6％) had mitral valve repair( MVP),33 (28.7 ％) had aortic valve replacement (AVR),16 ( 13.9 ％ ) had AVR +MVR,5(4.3％ ) had AVR + MVP,and 3 had tricuspid replacement.The concomitant procedures included left atrial thrombus scavenging in 18( 15.7％ ),tricuspid valvularplasty in 71 (61.7 ％ ),bental procedure in 6 (5.2 ％ ),and coronary artery bypass grafting(CABG) in 15 ( 13.0 ％).ResultsThe early mortality was 0.87 ％.The major complications included sever low cardiac output syndrome in 6 patients,transient atrial fibrillation in 17,acute renal failure requiring dialysis in 3,delayed ventilation assistance in 12,and stroke in 3.112 (97.4％) patients survived during 6 months period of follow-up,in whom only 8(7.14％) were in NYHA functional class Ⅲ-Ⅳ which was lower significantly compared with that preoperatively.ConclusionHeart valve surgery for elderly patients can get satisfactory result and early mortality and major mortality is low for them.Concerns over the risk of cardiac valve surgery in the elderly should not prevent referral,and elderly patients can do well.