Postoperative outcomes and perioperative risk factors in elderly patients with heart valve and coronary artery disease

Objective. To analyze postoperative outcomes in elderly patients with aortic and mitral valve disease, concomitant coronary artery disease; to identify perioperative risk factors for in-hospital mortality. Material and methods. Treatment outcomes were analyzed in 179 patients over 70 years old between January 2010 and December 2022. Heart valve repair or replacement combined with coronary artery bypass grafting was performed in all cases. Mean age of patients was 73.7±2.8 years, EuroSCORE II — 5.2±3.7%. Results. Overall postoperative mortality was 9.5% (n=17). In-hospital mortality after aortic valve replacement and coronary artery bypass grafting was 6.5% (8 patients). Left ventricular ejection fraction, heart failure NYHA class IV, diabetes mellitus, chronic obstructive pulmonary disease, obesity, atrial fibrillation, chronic kidney disease and carotid artery stenosis were associated with higher mortality. Prolonged aortic cross-clamping and cardiopulmonary bypass time, ischemic mitral regurgitation, severe intraoperative blood loss and emergency surgery increased the risk of mortality. Conclusion. Surgical treatment of elderly patients with valvular lesions and coronary artery disease should be carried out taking into account concomitant risk factors. Minimization of surgical injuries, intraoperative blood loss, time of surgery and cardiopulmonary bypass is important.