Open Heart Surgery in the Elderly1

A general reluctance to submit to open heart surgery elderly patients with acquired cardiac defects has wanned with increasing experience. Thirty‐five of 150 patients operated upon in 1971 were in fact over 60 years of age (23%). The first 100 elderly patients so operated upon have been selected for detailed study, and the results are presented. Results were excellent in patients with isolated aortic valve disease and coronary artery disease. They were satisfactory in those with isolated mitral valve disease, but generally disappointing following multiple valve procedures. It is considered that age alone should not be a contraindication to the proper selection of patients for cardiac surgery. Summary The results in 100 consecutive open heart procedures in patients aged 60 years of age and over are discussed. There has been a progressive increase in acceptance of the elderly patient as improvement in results has occurred. The results have been excellent in patients having isolated aortic valve replacement (8.5% early and 12% late mortality) and corrective procedures for coronary artery disease (no mortality). They were less satisfactory in patients having isolated mitral valve replacement (23% early and 16% late mortality), and were discouraging in patients having multiple valve replacement (25% early and 37% late mortality). The highe, mortality in these two groups is related to chronic mitral valve obstruction producing pulmonary disease, right ventricular failure and chronic systemic venous congestion. In the absence of such factors, age alone does not contraindicate open heart surgery.