Valvular heart disease and comorbid ischemic heart disease in patients over 65 years old

Andrzej Walczak¹, Janusz Zaslonka¹, Alicja Iwaszkiewicz¹, Ryszard Jaszewski¹, Marzenna Zielinska², Slawomir Jander¹, Leszek Markuszewski¹, Stanislaw Ostrowski¹

Summary
Background: Aging of societies is a worldwide tendency which concerns also the Polish population. Thus, patients referred to the surgery are older and older.
Material and methods: All valve replacements performed in the Department of Cardiac Surgery, Medical University of Łódź, between 1999 and 2002, were analyzed in the study. Patients older than 40 years, who were qualified to valve replacement under cardiopulmonary by-pass, underwent routine coronary angiography in order to assess their coronary circulation. Two groups of patients, under and over 65 years of age were compared from the point of view of an incidence of coronary arteries lesions and a need of myocardial revascularization. Totally, 1117 patients with valve replacement were analyzed
Results: In 15% (172 patients) of the whole analyzed group, simultaneous surgical myocardial revascularization was performed. In the subset of patients in whom it was necessary to perform CABG, persons over 65 made up 51%. Revascularization procedures more frequently accompanied AVR than MVR (60% vs. 40%). In the subset of patients over 65 who underwent combined procedures of valve replacement and CABG, women were twice as numerous as in the subset of younger patients.
Conclusions: Along with aging, an incidence of comorbid ischemic heart disease increases, what significantly rises a risk of the surgery (especially of mitral valve). It should be emphasized that some of the patients with advanced valvular disease do not suffer from typical sings of ischemic heart disease (angina) what is connected with their poor exercise tolerance.

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