Cardiac surgery in patients aged 80 years and older

Abstract

Objective: We studied disease and surgical outcomes in an 80-plus age group to determine the feasibility of cardiac surgery at this age.Methods: Between January 1991 and August 2000, we statistically analyzed 19 variables in 62 consecutive cases of cardiac surgery in the 80-plus age group to predict in-hospital and longterm mortality. Cases were classified by disease type (ischemic heart disease (IHD), n=39; valvular heart disease (VHD) n=19; and mechanical complications associated with acute myocardial infarction, n=4; and by surgical status (emergency, n=6; urgent, n=10; and elective, n=46). We compared these with 370 patients 70 to 79 years undergoing similar procedures during the same interval.Results: No significant difference was seen between groups in total in-hospital mortality—9.7% vs. 3.8%—or in-hospital mortality for IHD—2.6% vs.4.2%—or VHD—10.5% vs.2.8%. We found cardiopulmonary bypass time>150 min. and dialysis to be independent risk factors for hospital death. Actuarial survival at 7.5 years overall was 39% in the 80-plus age group vs. 53% in the 70–79 age group for VHD and 38% in the 80-plus age group vs. 62% in the 70–79 age group. No significant difference was seen in survival between groups for IHD. Stroke proved to be an independent prognostic factor.Conclusions: Cardiac surgery is conducted feasibly in selected octogenarians, providing acceptable mortality and results similar to those achieved in those 70 to 79 years old.