Multiple Valve Surgery in Octogenarians - Worth the Effort?

Objectives: Cardiac surgery progressively is faced with more and more elderly patients. Due to their unique physiology and susceptibility to morbidity, tailor-made treatment strategies are warranted. Herein we describe the clinical and follow-up results after multiple valve surgery in octogenarians.

Patients and methods: Since 2000 a total of 3.323 patients older 80 years underwent cardiac surgery. Out of these, 101 patients (3.0%) received multiple valve surgery. Mean patient's age was 82.0 years ± 1.9 years. Computed logistic EuroScore averaged 25.3 ±19.5%. Mean follow-up time was 277 ± 47 days, equaling a total of 442 patient-months.

Results: Surgery consisted of double valve procedures in 88.1% and in 11.9% of triple valve surgery. Mean hospital stay was 16.1 ± 9.7 days, hospital mortality 13.9%. During follow-up 43.8% of the patients died. Corresponding 6-months and 1-year survival was 40.1% and 28.6%, respectively. Main postoperative morbidity consisted of respiratory failure (17.3%), stroke (2.2%), delirium (22.3%) and renal failure (13.8%). Only 40 patients (39.6%) were free from postoperative complications. If any complications occurred, hospital mortality dramatically increased from 5.0% to 20.0%.

Conclusion: Octogenarians are demanding patients. Occurrence of any complication after multiple valve surgery resulted in multiplied mortality. Particularly in the era of TAVI, the indication for multiple valve surgery should be made with a jealous watch on medical condition, complaints and patient's motivation. It has to be discussed, whether catheter-based treatment of the leading vitium might suffice or not.