Abstract
Introduction
The number of patients with an indication for cardiac surgery in their ninth decade of life is increasing. This study analyses the single-center results with combined and redo cardiac surgical procedures in octogenarians retrospectively.
Patients and methods
Three groups were evaluated: (I) Two hundred and thirty six patients with combined cardiac surgical procedures, mean age 83.1 ± 2.5 years, 107 male (129 female). Combined aortic valve replacement (AVR) and aorto coronary bypass (ACB) was done in 215, double valve replacement (DVR) in 21. (II) AVR + ACB-group: 215 patients out of group I. (III) Control group consisting of 124 patients with a mean age of 74.1 ± 2.8 years (range 70–79.9 years) who received combined AVR and ACB. Risk stratification was done using the additive and logistic Euro-score; values are given as mean ± standard deviation and were compared using either the t-test or the Chi-square test.
Results
The observed mortality in group I was 9.3%. Re-intubation was observed in 10.2% and was one major risk factor for in-hospital mortality. As second risk factor, DVR could be identified. 14.8% required hemodialysis postoperatively, but this affected only the length of stay on intensive care unit (ICU) but not mortality. When comparing group II with group III, mortality was higher (10% vs. 4%), the need for hemodialysis was more frequent (16.3% vs. 4.9%), and the incidence of postoperative psycho-syndromes was also higher (26% vs. 8.1%, all: P < 0.05). The duration of ventilation (2.7 ± 7.7 vs. 1.6 ± 4.3 days) and the length of stay on ICU (8.2 ± 8.8 vs. 5.7 ± 6.4) were longer without reaching statistical significance (P > 0.05). The Euro-score overestimated the real mortality in all groups.
Conclusions
Octogenarians requiring combined cardiac surgical procedures required more resources and had a higher in-hospital mortality compared to younger patients. The observed in-hospital mortality was much lower than the predicted justifying the indication for surgical therapy in these patients. Patient selection, however, seems to be important but the Euro-score alone was rather ineffective in predicting poor outcome.
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Gulbins, H., Malkoc, A. & Ennker, J. Combined cardiac surgical procedures in octogenarians: operative outcome. Clin Res Cardiol 97, 176–180 (2008). https://doi.org/10.1007/s00392-007-0615-8
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DOI: https://doi.org/10.1007/s00392-007-0615-8