Manuseio cirúrgico da valva aórtico em pacientes acima de 70 anos / Surgical management of the aortic valve diasease in the elderly

RESUMO

Objetivo - Verificar o beneficio a curto e a longo prazo de pacientes submetidos a troca valvar aórtica isolada e a troca valvar associada a revascularizaçäo do miocárdio (RM), avaliar a incidência das complicaçöes pós-operatórias (CPO), mortalidade hospitalar (MH) e mortalidade tardia (MT). Métodos - Vinte pacientes foram tratados cirurgicamente entre janeiro de 1985 e dezembro de 1989, 75% (15 pacientes) do sexo masculino e 25% (5 pacientes) do sexo feminino, variando as idades entre 70 e 86 (média = 74,8) anos e com gradiente valvar aórtico entre 78 e 180 mmHg (média = 97 mmHg), com diagnóstico pré-operatório de estenose aórtica (EA) isolada ou EA associada com insuficiência coronariana (ICo). Estavam em grau funcional (NYHA) I - O paciente; II - 3 pacientes (15%); III - 14 pacientes (70%) e IV - 3 pacientes (15%). Resultados - As CPO mais freqüentes foram: intubaçäo prolongada em 7 pacientes (35%), sangramento em 4 pacientes (20%), insuficiência renal aguda em 3 pacientes e arritmia ventricular em 3 pacientes (15%). A MH foi de 10% (2 paciente), todos com cirurgia de troca valvar associada a RM. A MT foi de 5% (1 paciente). Até dezembro de 1989, 11 pacientes (64%) encontravam-se em grau funcional I, 3 pacientes (18%) em II, 3 pacientes (18%) em III e nenhum em IV. Conclusäo - A idade avançada näo é uma contra-indicaçäo de cirurgia para os pacientes com estnose aórtica isolada ou associada com ICo. Em relaçäo ao pré-operatório houve uma significativa melhora do grau funcional (NYHA) dos pacientes sobreviventes

ABSTRACT

Purpose - To assess the short and long-term benefits of patients who were submitted to isolated aortic valve replacement or valve replacement (VR) concomitant myocardial revascularization (MR); to evaluate the incidence of postoperative complications, hospital mortality and late mortality. Methods -- From January 1985, through December 1989, 20 consecutive patients underwent surgical intervention, 15 male (75%) and 5 female (25%), the mean age was 74.8% (ranging from 70 to 86 years old ), and the aortic valve gradient ranged between 78 and 180 mmHg (mean = 97 mmHg). They presented preoperative diagnosis to have either isolated aortic stenosis (AS) or As and coronary artery disease (CAD). No patient was in NYHA functional class I; 3 patients (15%) were in class II, 14 (70% ) in class III and 3 (15%), in class IV. Results - The most frequent post-operative complications found were: extended intubation in 7 patients (35%), bleeding in 4 (20%), acute renal failure in 3 (15% ) and ventricular arrhythmia in 3 (15%). Hospital mortality ocurred in 2 patients (10%) who had been submitted to VR and concomitant MR. Late mortality occurred in 1 patient (5%). Through Dezember 1989,11 patients (64%) were in functional classe I (NYHA), 3 (18%) in class II, 3 (18%) in classe III and none in class IV. Conclusion - We concluded that the surgical treatment is indicate to elderly patients with isolated AS os with AS and concomitant CAD. There was a significant post-operative improvement of the functional class (NYHA) to the surviving patients