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Geriatric heart replacement
My 76 year old grandmother is undergoing valve replacement surgury and I was wondering what the suvival rates and complication statistics generally speaking are for immediately postoperative and for the following months and years? Can you refer me to a web page or do you know?
I just found this article
Valve Replacement
The majority of patients undergoing valve replacement are elderly. Valvuloplasty is sometimes an option, especially for patients who may be unable to tolerate more aggressive procedures or who have limited life expectancy.
The most common indication for aortic valve replacement is aortic stenosis, which, in the elderly, is most commonly caused by degenerative (senile) calcification and postinflammatory (primarily rheumatic) aortic valve disease, whose incidence has declined markedly. Although not common among the elderly, aortic regurgitation is another indication. The most common indication for mitral valve replacement is mitral regurgitation or mitral stenosis, which is increasingly caused by degenerative mitral valve disease rather than by rheumatic heart disease.
Age alone does not contraindicate valve replacement or repair. The indications for surgery in the elderly are similar to those in younger patients: the severity of symptoms, the nature of the valve lesion (whether regurgitant or stenotic), the cause of the disorder, and left ventricular function.
Prognosis
Newer techniques have improved the prognosis of valve replacement in the elderly. Although results are comparable among older and younger patients, old age is generally considered a significant risk factor for early mortality and morbidity, partly because of the high incidence of coexisting disorders in elderly patients. However, in many elderly patients, survival and quality of life can be improved with valve replacement or repair.
The overall perioperative mortality rate for aortic valve replacement in elderly patients is 10.5% (range, 5 to 28%), which is higher than that in younger patients. The perioperative mortality rate is higher for those with aortic valve insufficiency than for those with aortic stenosis; it is also higher for those undergoing emergency and urgent operations and for those who have poor left ventricular function, chronic lung disease, peripheral vascular disease, or renal impairment. For elderly patients with aortic stenosis undergoing nonemergency valve replacement in recent years, the perioperative mortality rate is reported to be as low as 4 to 5%, and the surgical mortality rate is 5 to 10%, even if heart failure is present.
The perioperative mortality rate is higher for patients undergoing aortic valve replacement combined with CABG than for those undergoing aortic valve replacement alone (4 to 6% for patients in their mid-70s, 10% for patients in their 80s). The mortality rate for patients undergoing multiple valve replacements is also considerably higher than that for patients undergoing one valve replacement.
The postoperative morbidity rate is higher for elderly patients than for younger patients. Respiratory distress, bleeding, supraventricular arrhythmias, conduction disturbances, delayed wound healing, psychoses, and stroke occur more frequently in elderly patients postoperatively.
Extended long-term survival and symptomatic relief in a symptomatic elderly patient (even in a nonagenarian) with severe valvular heart disease are usually obtained using aortic valve replacement. The long-term survival rate with valve replacement--about 70% at 5 years--appears far superior to that attainable with drug therapy alone. The survival rate for elderly patients undergoing successful operations is similar to that for an age-matched population without valvular disease.
Mitral valve replacement is associated with less complete relief of symptoms and a higher mortality rate than aortic valve replacement, but the mortality rate has improved substantially in recent years. A large percentage of deaths are due to embolic stroke.
Preoperative Assessment
An assessment of the severity of symptoms, coexisting cardiac and noncardiac disorders, and psychosocial factors is important. Coronary angiography is generally performed to identify any significant coronary stenoses for possible revascularization during surgery. In a patient with aortic stenosis, poor left ventricular function does not contraindicate surgery if the mechanical effects of the valve lesion are the primary cause of the patient's symptoms. In a patient with valvular insufficiency, a prolonged delay in surgery may result in irreversible left ventricular dysfunction, with a markedly adverse effect on early and late results.
The choice of a valve warrants a comprehensive preoperative assessment and discussion with the patient, although the final decision often can be made only during the operation. Mechanical prosthetic valves are associated with a high risk of thromboembolism, and anticoagulant therapy is required. In patients with atrial fibrillation or other conditions, anticoagulation may already be necessary; a mechanical valve, with its increased durability, may therefore be a good choice for these patients. Favorable hemodynamic characteristics may warrant the use of certain low-profile mechanical valves (eg, St. Jude Medical, Medtronic-Hall) in specific cases.
Bioprosthetic valves are associated with a lower risk of thromboembolism than mechanical valves are, especially if atrial fibrillation is absent, and they do not require anticoagulant therapy. Bioprosthetic valves (eg, Carpentier-Edwards, Hancock) are generally recommended for patients >= 70, for whom the risks of long-term anticoagulant therapy (required for mechanical valves) are higher than those for younger patients. Moreover, bioprosthetic valves do not deteriorate or calcify as rapidly in elderly patients as they do in younger patients.
For patients with coexisting coronary artery stenosis, the question is whether CABG should be performed concomitantly with valve replacement, particularly in patients who do not have angina or prior myocardial infarction. Concomitant CABG increases the operative mortality rate, primarily because more time is required for cardiopulmonary bypass; although this increase has diminished in recent years, no randomized controlled study has compared concomitant surgery with separate procedures. Generally, concomitant CABG should be performed in patients with severely obstructed but operable coronary arteries, even if they do not have angina. However, the decision to perform concomitant CABG should be based on the clinical and hemodynamic status of the patient preoperatively and intraoperatively.
For patients with regurgitation due to coronary artery disease affecting the papillary muscle and the supporting left ventricular wall, CABG and valvuloplasty using an annuloplasty ring are often performed together. Surgical plication or valvuloplasty may be effective when the cause is myxomatous degeneration.
good luck and I hope this helps
michelle
Valve Replacement
The majority of patients undergoing valve replacement are elderly. Valvuloplasty is sometimes an option, especially for patients who may be unable to tolerate more aggressive procedures or who have limited life expectancy.
The most common indication for aortic valve replacement is aortic stenosis, which, in the elderly, is most commonly caused by degenerative (senile) calcification and postinflammatory (primarily rheumatic) aortic valve disease, whose incidence has declined markedly. Although not common among the elderly, aortic regurgitation is another indication. The most common indication for mitral valve replacement is mitral regurgitation or mitral stenosis, which is increasingly caused by degenerative mitral valve disease rather than by rheumatic heart disease.
Age alone does not contraindicate valve replacement or repair. The indications for surgery in the elderly are similar to those in younger patients: the severity of symptoms, the nature of the valve lesion (whether regurgitant or stenotic), the cause of the disorder, and left ventricular function.
Prognosis
Newer techniques have improved the prognosis of valve replacement in the elderly. Although results are comparable among older and younger patients, old age is generally considered a significant risk factor for early mortality and morbidity, partly because of the high incidence of coexisting disorders in elderly patients. However, in many elderly patients, survival and quality of life can be improved with valve replacement or repair.
The overall perioperative mortality rate for aortic valve replacement in elderly patients is 10.5% (range, 5 to 28%), which is higher than that in younger patients. The perioperative mortality rate is higher for those with aortic valve insufficiency than for those with aortic stenosis; it is also higher for those undergoing emergency and urgent operations and for those who have poor left ventricular function, chronic lung disease, peripheral vascular disease, or renal impairment. For elderly patients with aortic stenosis undergoing nonemergency valve replacement in recent years, the perioperative mortality rate is reported to be as low as 4 to 5%, and the surgical mortality rate is 5 to 10%, even if heart failure is present.
The perioperative mortality rate is higher for patients undergoing aortic valve replacement combined with CABG than for those undergoing aortic valve replacement alone (4 to 6% for patients in their mid-70s, 10% for patients in their 80s). The mortality rate for patients undergoing multiple valve replacements is also considerably higher than that for patients undergoing one valve replacement.
The postoperative morbidity rate is higher for elderly patients than for younger patients. Respiratory distress, bleeding, supraventricular arrhythmias, conduction disturbances, delayed wound healing, psychoses, and stroke occur more frequently in elderly patients postoperatively.
Extended long-term survival and symptomatic relief in a symptomatic elderly patient (even in a nonagenarian) with severe valvular heart disease are usually obtained using aortic valve replacement. The long-term survival rate with valve replacement--about 70% at 5 years--appears far superior to that attainable with drug therapy alone. The survival rate for elderly patients undergoing successful operations is similar to that for an age-matched population without valvular disease.
Mitral valve replacement is associated with less complete relief of symptoms and a higher mortality rate than aortic valve replacement, but the mortality rate has improved substantially in recent years. A large percentage of deaths are due to embolic stroke.
Preoperative Assessment
An assessment of the severity of symptoms, coexisting cardiac and noncardiac disorders, and psychosocial factors is important. Coronary angiography is generally performed to identify any significant coronary stenoses for possible revascularization during surgery. In a patient with aortic stenosis, poor left ventricular function does not contraindicate surgery if the mechanical effects of the valve lesion are the primary cause of the patient's symptoms. In a patient with valvular insufficiency, a prolonged delay in surgery may result in irreversible left ventricular dysfunction, with a markedly adverse effect on early and late results.
The choice of a valve warrants a comprehensive preoperative assessment and discussion with the patient, although the final decision often can be made only during the operation. Mechanical prosthetic valves are associated with a high risk of thromboembolism, and anticoagulant therapy is required. In patients with atrial fibrillation or other conditions, anticoagulation may already be necessary; a mechanical valve, with its increased durability, may therefore be a good choice for these patients. Favorable hemodynamic characteristics may warrant the use of certain low-profile mechanical valves (eg, St. Jude Medical, Medtronic-Hall) in specific cases.
Bioprosthetic valves are associated with a lower risk of thromboembolism than mechanical valves are, especially if atrial fibrillation is absent, and they do not require anticoagulant therapy. Bioprosthetic valves (eg, Carpentier-Edwards, Hancock) are generally recommended for patients >= 70, for whom the risks of long-term anticoagulant therapy (required for mechanical valves) are higher than those for younger patients. Moreover, bioprosthetic valves do not deteriorate or calcify as rapidly in elderly patients as they do in younger patients.
For patients with coexisting coronary artery stenosis, the question is whether CABG should be performed concomitantly with valve replacement, particularly in patients who do not have angina or prior myocardial infarction. Concomitant CABG increases the operative mortality rate, primarily because more time is required for cardiopulmonary bypass; although this increase has diminished in recent years, no randomized controlled study has compared concomitant surgery with separate procedures. Generally, concomitant CABG should be performed in patients with severely obstructed but operable coronary arteries, even if they do not have angina. However, the decision to perform concomitant CABG should be based on the clinical and hemodynamic status of the patient preoperatively and intraoperatively.
For patients with regurgitation due to coronary artery disease affecting the papillary muscle and the supporting left ventricular wall, CABG and valvuloplasty using an annuloplasty ring are often performed together. Surgical plication or valvuloplasty may be effective when the cause is myxomatous degeneration.
good luck and I hope this helps
michelle
my grandfather had vavle replacement surgery when he was 76 and he was okay. I honestly don't remember too much about it, that was 16 years ago. all I know is he wasn't in top notch health and he did fine. I do know that this was his 2nd one they replaced. if I can remember correctly they have to replace them every so often.
I will see if i can't find anyting out on the web
michelle
I will see if i can't find anyting out on the web
michelle
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