AN AUDIT OF CARDIAC-SURGERY IN PATIENTS AGED OVER 70 YEARS

With an increasingly aged population, the number of patients requiring treatment for cardiovascular diseases will rise. Previous expectation s of cardiac surgery in the over-seventies have been poor, with surger y being very much a last resort. We decided to test whether this was a ppropriate, and to determine whether the priority of surgery affected the outcome. Three hundred and six patients over the age of 70 were op erated on in our unit in a 4 1/2-year period, 210 as elective operatio ns and 96 as emergencies. Eighty-nine per cent were in NYHA class III- IV pre-operatively and half had other significant medical problems. Mo st (46%) underwent coronary artery surgery. The methods used were iden tical to those used for the younger patients in both operative approac h and post-operative management. The overall mortality was 6.9%; 1.9% for elective procedures and 16.7% for emergencies (12.3% when catastro phic pathologies are excluded). However, the morbidity was not signifi cantly different between the two groups and the length of post-operati ve ventilation and hospital stay were likewise not significantly diffe rent. Follow-up of the survivors showed no late deaths, and 87% were i n NYHA class I and II. Of the others, 25 have required additional hosp ital admissions for associated cardiac problems. One required another invasive procedure (a PTCA), but none has required further surgery. Th e findings of low mortality for elective cardiac surgery in this age g roup are in agreement with other reports. If early referral prevents e mergency surgery, it should be avidly pursued, in view of the improved outcome for elective surgery. It may also secondarily reduce the numb er of hospital admissions and lower drug requirements.