CARDIAC-SURGERY IN PATIENTS AGED 80 YEARS AND ABOVE - DOES OUTCOME JUSTIFY SIGNIFICANT PERIOPERATIVE MORBIDITY

Purpose: Cardiac surgery in octogenarians is a routine procedure in th e 1990s, but escalating medical costs, limited resources and a demand for cost-effective medical care have created a need for systematic ris k stratification and cost-benefit analyses. Against this background we began in 1990 a prospective study to analyze preoperative and operati ve risk factors as predictors of postoperative morbidity. Patients and methods: 50 consecutive patients aged 80 years and above (median: 80. 5 years; interquartile range (IQR): 80.0-82.25, total range (TR): 80-9 2 years), of whom 23 (46%) were male, who underwent open heart surgery at our institution between January 1990 and December 1993 were includ ed in this prospective study. Before surgery, most patients were sever ely symptomatic and in functional New York Heart Association (NYHA) cl asses III (46%) or IV (42%). Thirty-one patients (62%) underwent isola ted coronary artery bypass grafting (CABG), 12 (24%) had aortic valve replacement (AVR), five (10%) had CABG combined with AVR or double val ve replacement and two (4%) had mitral valve repair. Follow-up (median : 19.5 months, IQR: 12.0-28.0, TR: 5-52) was focused on long-term morb idity. Clinical endpoints monitored were: any major or minor postopera tive complication, 30-day overall mortalitiy, functional status, morbi dity and mortality in the follow-up period. Statistical analysis was p erformed for 15 preoperative and operative risk factors. Results: The 30-day overall mortality was 8.0%. The postoperative course was uneven tful only for 18 (36%) of our patients. Risk factors predictive of pos toperative morbidity were: preoperative NYHA class (P less than or equ al to 0.02), left main stem disease (P less than or equal to 0.001), e jection fraction < 45% (P less than or equal to 0.003), diabetes melli tus (P less than or equal to 0.01), AVR or combined procedures versus CABG (P less than or equal to 0.007), bypass time (P less than or equa l to 0.02) and duration of aortic cross-clamping (P less than or equal to 0.001). Late morbidity was not related to postoperative complicati ons. Cumulative survival was 88% and 83% at 1 or 2 years, respectively . After discharge, 38 patients (88.4%) were in NYHA functional class I or II. Conclusion: We conclude from the good long-term results in our patient population that, although cardiac surgery incurs a higher per ioperative risk (and costs) in octogenarians than it does in younger p atients, it may nevertheless be a reasonable therapeutic option for ol der patients with symptomatic heart disease.