Surgical Management of Aortic Valve Disease in the Elderly

Forty patients over the age of 70 years, with an average age of 74.6 years, have undergone aortic valve surgery at the Massachusetts General Hospital in the past eight years. Thirty-eight patients had calcific aortic stenosis, and two had aortic insufficiency. Debridement of the aortic valve was performed early in our experience in the surgical treatment of aortic stenosis in four patients, three of whom survived. Two of these patients as well as the other thirty-six underwent prosthetic aortic valve replacement. In this group of 40 patients, 32 of whom were in cardiac class IV, there were eight hospital deaths (20%) and three late deaths (7.5%). The 29 survivors are all much improved, and some spectacularly so. These results justify an aggressive approach to aortic valve replacement in the elderly, if the patient's general status warrants it.