EFFICACY OF COMBINED CORONARY REVASCULARIZATION AND VALVE PROCEDURES IN OCTOGENARIANS

From January 1982 to October 1991, 42 consecutive patients 80 years of age and older underwent a combined cardiac procedure with coronary re vascularization and valve repair or replacement. There were 20 women a nd 22 men, Mean age at operation was 82.8 years (range, 80 to 89.7 yea rs), Twenty-seven patients (64%) were in New York Heart Association (N YHA) functional class III or IV preoperatively. Six patients (14.3%) h ad undergone previous cardiac procedures. There were six hospital deat hs (14.3%). The only significant preoperative risk factor identified f or the event hospital death was aortic insufficiency (p=0.005), The 36 hospital survivors were followed up at a mean of 21.1 months after ho spital discharge, There were nine (21%) late deaths occulting at a mea n of 21.3 months postoperatively: two from acute myocardial infarction s and seven from chronic heart failure, Survival analysis indicated th at higher preoperative NYHA class (p=0.0003), hypertension (p=0.015), hypercholesterolemia (p=0.03), and elevated left atrial/left ventricul ar gradient (p=0.04) were incremental risk factors for overall mortali ty, The actuarial survival at 40 months was 51.9%, with no significant difference as compared with an age-, sex-, and race-matched populatio n. Of the 27 late survivors, 26 were in NYHA class I or II. We conclud e that octogenarians may undergo complex cardiac surgical procedures w ith an expectation of an acceptable mortality rate and significant imp rovement in their functional status, These results must be taken into consideration in light of reported strategies to ameliorate health-car e costs by limiting availability of complex medical care to the elderl y.