Surgical outcomes and prognostic factors in elderly Chinese patients with valvular heart disease: a multi-center retrospective cohort study

Abstract Objective To investigate surgical outcomes and prognostic factors in elderly patients (≥ 60 years) with valvular heart disease (VHD) undergoing surgery, and to provide evidence for optimizing clinical decision-making. Methods A retrospective analysis was conducted on 347 elderly VHD patients who underwent valve surgery across three Chinese centers from December 2021 to June 2025. Baseline characteristics, comorbidities, preoperative cardiac function, surgical details, complications, and follow-up data were collected. Cumulative survival was estimated using Kaplan–Meier method, with subgroup comparisons by log-rank test. Independent prognostic factors were identified using multivariable Cox regression. Results Among 347 patients (53.9% male, mean age 68.8 ± 5.5 years), hypertension (62.0%), diabetes (28.0%), and COPD (15.0%) were common. Multi-valvular disease (58.8%) was the predominant lesion. Postoperative complications occurred in 28.0%, most frequently pulmonary infection (12.1%), arrhythmia (8.1%), and acute kidney injury (4.9%). In-hospital mortality was 2.9% ( n = 10). At median 24-month follow-up, 66 patients died. The 1-, 2-, and 3-year survival rates were 91.9%, 85.9%, and 81.0%, respectively. Multivariable analysis identified age ≥ 75 years (HR = 3.25, 95%CI:1.28–8.23, P = 0.014), reduced preoperative LVEF (HR = 2.89, 95%CI:1.15–7.26, P = 0.024), and postoperative complications (HR = 4.12, 95%CI:1.65–10.28, P = 0.002) as independent risk factors for poor prognosis. Conclusion Elderly VHD patients achieve favorable outcomes with acceptable mortality. This is one of the few contemporary multicenter studies specifically reporting 3-year medium-term survival outcomes among Chinese elderly patients with valvular heart disease, filling a regional evidence gap in this population. Comprehensive preoperative evaluation, individualized planning, and rigorous perioperative care are essential, particularly for those aged ≥ 75 years, with reduced LVEF, or developing complications.