Severe aortic stenosis in patients 60 years of age or older: left ventricular function and 10-year survival after valve replacement.

From 1962-1977, 99 patients, mean age 65 +/- 0.5 years (range 60-81 years) underwent valve replacement for severe calcific aortic valve stenosis. Ninety-three percent of the patients were in New York Heart Association functional class III or IV. The aortic valve gradient was 76 +/- 3 mm Hg and the aortic valve area index was 0.34 +/- 0.01 cm2/m2. Left ventricular systolic pressure was 207 +/- 4 mm Hg, cardiac index was 2.5 +/- 0.1 l/min/m2, left ventricular ejection fraction was 0.57 +/- 0.02 and left ventricular end-diastolic volume index was 108 +/- 60 ml/m2; left ventricular ejection fraction and end-diastolic volume were normal in 63% of the patients. The operative mortality was 16%. Mean follow-up is 55 +/- 4 months. Using life-table analysis, the 10-year survival, excluding cardiac deaths, is 57.5 +/- 7%. Ninety-one percent of the survivors are in functional class I or II. We conclude that the left ventricular function is normal in two-thirds of elderly patients with severe aortic valve stenosis. After valve replacement, the 10-year survival is most encouraging and most of the survivors are functionally improved.