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Prognosis and Quality of Life After Valve Surgery in Patients Older Than 75 Years FREE TO VIEW

Oz M. Shapira; Ruth M. Kelleher; Julian Zelingher; Deborah Whalen; Carmel Fitzgerald; Gabriel S. Aldea; Richard J. Shemin
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From the Department of Cardiothoracic Surgery, Boston Medical Center

1997 by the American College of Chest Physicians

Chest. 1997;112(4):885-894. doi:10.1378/chest.112.4.885
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Background: Assessment of quality of life has become an increasingly important aspect of the risk-benefit analysis of any therapeutic intervention, particularly in high-risk populations, such as the elderly.

Methods: Clinical outcomes of 147 consecutive patients older than 75 years undergoing valve surgery between 1992 and 1995 were reviewed. Long-term quality of life was assessed using a modified version of the Duke University Medical Outcomes Study system.

Results: Mean age was 79.3±4 years, range was 75 to 89 years, and 67% (99/147) were male. Preoperatively, 128 patients (87%) were in New York Heart Association (NYHA) functional class III/IV. Fifty-two percent (77/147) of the operations were nonelective. Concomitant coronary artery bypass grafting was performed in 69 patients (47%). Thirty-day hospital mortality was 7.5% (11/147). Mean follow-up for 98% (133/136) of hospital survivors was 30±13 months (range, 2 to 55 months). Actuarial survival at 55 months was 71±6%—equivalent to a general age-, race-, and gender-matched population reported in the Life Tables of the US National Center for Health Statistics. At the time of follow-up, 112 patients (96%) lived at home, 78% (91/116) defined their health between good to excellent, and 81% (93/114) stated that the operation improved their health status. Ninety-seven percent (112/116) were able to bathe and dress independently, 92% (104/113) could walk at least one block, and 88.5% (100/113) could climb at least one flight of stairs. Moderate to vigorous activities could be performed by 59.2% (67/113). Overall, at the time of follow-up, 81% (95/117) were in NYHA class I/II.

Conclusion: In a selected patient population, valve surgery in the elderly is associated with acceptable early morbidity and mortality. Long-term survival and quality of life are excellent. These facts strongly support the performance of these procedures in patients older than 75 years.




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