CARDIAC-SURGERY IN THE ELDERLY - IMMEDIAT E AND MEDIUM-TERM RESULTS IN 100 PATIENTS OVER 75 YEARS OF AGE

With improved operative technique and postoperative care, progressivel y older patients are being referred for cardiac surgery. One hundred o ut of 633 patients operated between September 1990 and December 1992, were over 75 years of age (Group I). These patients were compared with the last 100 patients under 75 years of age (Group II). Both groups w ere operated by the same surgical team with the same anaesthetic, card iopulmonary bypass and myocardial protection techniques. The average a ge of the groups was 79.5 +/- 3.1 and 62.1 +/- 9.2 years, respectively . The procedures performed were : myocardial revascularisation (Group I, 28 cases; Group II, 59 cases), aortic valve surgery alone or associ ated with coronary bypass (56 and 22 cases respectively), and mitral v alve surgery alone or associated with another procedure (11 and 12 cas es). There were no significant differences between the two groups with respect to true low output state, the duration of mechanical ventilat ion and of intensive care and hospital stay. On the other hand, there were significant differences in: the number of blood transfusions (44 cases versus 20, p < 0.001), the occurrence of atrial fibrillation (52 cases versus 29, p < 0.001) and neuropsychiatric disturbances (27 cas es versus 5, p < 0.0001). There were no cases of mediastinitis in eith er group. The hospital mortality was 6% in Group I and 5% in Group II (NS). The medium-term mortality after an interval of 5 to 32 months in the over 75 age group was 7 cases, including 4 cases of cerebrovascul ar accident. An enquiry was performed in the 87 survivors of Group I. It showed that 95.4% were leading lives that they considered to be nor mal and 85% claimed to have been improved by surgery. The authors conc lude that surgery in elderly patients gives acceptable results in the hospital period and a significant improvement in the quality of their life at medium-term.