Abstract
Objective
With progressive aging of population in developing nations, cardiac surgeons increasingly face elderly patients. These patients are usually symptomatic, yet at high risk for intervention. This study aims to review our experience in elderly Indian patients.
Methods
We reviewed the records of 128 elderly patients (mean age 74.6 years; range 70–84) operated at our institution from 2005 to 2009. Postoperatively, patients were followed-up in the out-patient-department.
Results
Surgery was performed on 10 as an emergency and 41 on an urgent (on the day of referral or the following day) basis. Mean left ventricular ejection fraction was 44% ± 9.5. Early mortality (during current admission or within 30 days of discharge from the hospital) was 12 (9.3%). Mean New York Heart Association functional class was improved from 3.0 ± 0.8 preoperatively to 1.5 ± 0.7 postoperatively. Median Intensive Care Unit and in-hospital stay was 4 days (range 1–17) and 12 days (range 4–37), respectively. Postoperative complications included pneumonia (6.3%), stroke (5.5%), reoperation for bleeding (4.6%) and intra-aortic balloon pump requirement (4.6%). Emergency surgery was significantly associated (P < 0.05) with an increased risk of early mortality- operative procedure and cardiopulmonary bypass time were not.
Conclusion
We conclude that cardiac surgery can be performed in elderly population with an acceptable early mortality. Postoperatively, patients attain an improved quality of life. Operative procedures and cardiopulmonary bypass times are not risk factors for increased mortality. Emergency surgery in this group of patients is less rewarding.
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References
An Aging World. Database Research Report issued June 2009 by National Institute of Aging, US National Institutes of Health, US Department of Health and Human Services; 2008. [Internet]. Available on: http://www.nia.nih.gov/ResearchInformation/ExtramuralPrograms/BehavioralAndSocialResearch/an-aging-world.htm and http://www.nia.nih.gov/NR/rdonlyres/FBC46426-ABF5-40F7-A0EF-C6A178B0B478/0/AgingWorld2008.pdf. Accessed 10/08/2010.
National Commission on Population, Government of India website [Internet]. Available on: http://populationcommission.nic.in/facts1.htm. Accessed 10/08/2010.
Unger F. The changing image in cardiac surgery. J Cardiovasc Surg. 1994;35:1–5.
Nissinen J, Wistbacka JO, Loponen P, et al. Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected. Ann Thorac Surg. 2010;89:1119–24.
Avery II GJ, Ley SJ, Hill JD, Hershon JJ, Dick SE. Cardiac surgery in the octogenarian: evaluation of risk, cost, and outcome. Ann Thorac Surg. 2001;71:591–6.
Chaturvedi RK, Blaise M, Verdon J, et al. Cardiac Surgery in octogenarians: long-term survival, functional status, living arrangements, and leisure activities. Ann Thorac Surg. 2010;89:805–10.
Barnett SD, Halpin LS, Speir AM, et al. Postoperative complications among octogenarians after cardiovascular surgery. Ann Thorac Surg. 2003;76:726–31.
Zingone B, Gatti G, Rauber E, et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg. 2009;87:71–8.
Kurlansky PA, Williams DB, Traad EA, Zucker M, Edward GE. Eighteen-year follow-up demonstrates prolonged survival and enhanced quality of life for octogenarians after coronary artery bypass grafting. J Thorac Cardiovasc Surg; June 2010. Available online 9 June 2010 at: [Internet] http://dx.doi.org/10.1016/j.jtcvs.2010.05.003.
Katz NM, Hannan RL, Hopkins RA, Wallace RB. Cardiac operations in patients aged 70 years and over: mortality, length of stay, and hospital charge. Ann Thorac Surg. 1995;60:96–100.
De Mol BA, Kallewaard M, Lewin F, Van Gaalen GL, Van Den Brink RB. Single-institution effectiveness assessment of open-heart surgery in octogenarians. Eur J Cardio-thorac Surg. 1997;12:285–90.
Chiappini B, Camurri N, Loforte A, DiMarco L, DiBartolomeo R, Marinelli G. Outcome after aortic valve replacement in octogenarians. Ann Thorac Surg. 2004;78:85–9.
Asimakopoulos G, Taylor KM. Octogenarians and cardiac surgery. Ann Thorac Surg. 2000;69:317–8.
Likosky DS, Dacey LJ, Baribeau YR, et al. Long-term survival of the very elderly undergoing coronary artery bypass grafting. Ann Thorac Surg. 2008;85:1233–7.
Sheridan BC, Stearns SC, Rossi JS, D’Arcy LP, Federspiel JJ, Carey TS. Three-year outcomes of multivessel revascularization in very elderly acute coronary syndrome patients. Ann Thorac Surg. 2010;89:1889–94.
Dalrymple-Hay MJR, Alzetani A, AboelNazar S, Haw M, Livesey S, Monro J. Cardiac surgery in the elderly. Eur J Cardio-thorac Surg. 1999;15:61–6.
Tsai T, Chaux A, Matloff J, et al. Ten year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg. 1994;58:445–50.
Asimakopoulos G, Edwards MB, Brannan J, Taylor KM. Survival and cause of death after mitral valve replacement in patients aged 80 years and over: collective results from the UK heart valve registry. Eur J Cardio-thorac Surg. 1997;11:922–8.
Fallowfield L. Quality of quality-of-life data. Lancet. 1996;348:421–2.
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Patil, N.P., Sevta, P., Dutta, N. et al. Contemporary perioperative results of cardiac surgery in the elderly- our experience. Indian J Thorac Cardiovasc Surg 27, 15–19 (2011). https://doi.org/10.1007/s12055-010-0076-y
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DOI: https://doi.org/10.1007/s12055-010-0076-y