Objective To summarize the clinical outcomes and experience in perioperative management in octogenarians undergoing cardiac valve replacement. Methods Fifty-six octogenarians underwent heart valve replacement with hypothermia and cardiopulmonary bypass, and the surgical outcomes, complications and followup findings were analyzed. Results Among the 56 patients, 4 died early after operation, and 52 (92.9%) discharged. There were 23 cases of complications, including respiratory failure, renal failure, ventricular arrhythmia, pleural effusion and pericardial effusion. Forty-two patients were followed up for more than 2 years, there were 31 patients with gradeⅡ of cardiac function and 11 patients with grade Ⅲ of cardiac function 2 years after operation, and the left atrial diameter was significantly smaller and the pulmonary arterial pressure was significantly lower 2 years after operation than those before operation (P<0.05). Conclusion With appropriate timing of operation and proper perioperative management, cardiac valve replacement may be feasible for octogenarians with cardiac valvular

disease.