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Valve disease
Cardiac valve surgery in the octogenarian
  1. René Prêtre,
  2. Marko I Turina
  1. Cardiovascular Surgery, University Hospital, Zürich, Switzerland
  1. Dr René Prêtre, Cardiovascular Surgery, University Hospital, 100 Rämistrasse, 8091 Zürich, Switzerland email:rene.pretre{at}

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As the human lifespan increases and healthcare quality improves, more people are reaching an advanced age only to present with cardiac disorders that are usually treated uneventfully in young patients. The balance between enhanced initial risks and reduced eventual benefits in the elderly has often led to difficult medical decisions, and at times painful ethical and economical considerations.

Although there may be, on an individual basis, a substantial discrepancy between chronological and physiological age, the ability of elderly patients to withstand a major physiological insult such as cardiac surgery is reduced because of associated comorbidities, limited functional reserve of vital organs, and diminished defence and adaptation capacities. In the 1970s, an increase in mortality after cardiac surgery was apparent in patients older than 70 years. With the development of less traumatic heart–lung machines, more effective myocardial protection strategies, and improved perioperative care, mortality in the more robust patients—that is, the septuagenarians—dropped to levels of younger age groups.1Nowadays, the range of benefit of cardiac surgery remains narrow in patients 80 years of age or older, the age group discussed here.


In the early 1990s, 7.4 million people (3% of the population) in the USA were older than 80 years. With a current life expectancy of 6.9 years for octogenarian men and 8.7 years for women, the number of octogenarians is expected to exceed 10 million (4.3 % of the population) by the year 2000. In England, the number will be 2 million. It is estimated that 40% of octogenarians have serious symptomatic heart disease. The number of elderly patients undergoing open heart surgery is increasing in all institutions. Because women outlive men by 6.9 years the ratio of women to men undergoing surgery increases and comes close to 1:1 in the older groups.

Principles of cardiac surgery in …

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