Cardiac operations in the elderly: Who is at risk?

Background. With the growing number of elderly patients presenting for card iac operations we analyzed their early survival data to determine whether a ny preoperative variables might be indicative of increased risk. Methods. From 1990 to 1995, 436 consecutive patients who were 75 years old or older had either coronary artery bypass, valve replacement(s), or a comb ination of these. A total of 34 preoperative variables were assessed for th eir effect on hospital survival by using univariate and multivariable analy sis. Results. There were 266 men and 170 women, with 292 patients being 75 to 80 years old and 144 patients being older than 80 years. Coronary artery bypa ss was performed in 242 patients, valve replacement was performed in 93 pat ients, and a combination of these in 101 patients. The operation was consid ered elective in 202 patients, urgent in 209, and emergent in 25 patients o f whom 21 were in cardiogenic shock. Overall there were 61 hospital deaths (13.9%). The most common cause of death, low cardiac output syndrome, occur red in 34 patients of whom 26 suffered a perioperative myocardial infarctio n. Stroke was the cause of death in eight and multiple organ failure accoun ted for nine deaths. In the univariate analysis, variables that influenced survival included heart failure (p = 0.004), pulmonary edema (p = 0.004), c ardiomegaly (p = 0.02), elevated serum creatinine (p 0.009), surgical prior ity (p = 0.002), and cardiogenic shock (p = 0.002). In the multivariable an alysis there were three independent determinants of hospital survival: card iomegaly (odds ratio, 1.8:1) serum creatinine level higher than 150 mu mol/ L (odds ratio, 5.5:1) and emergency procedure (odds ratio, 2.5:1). Conclusions. Although cardiac operations can be performed safely in many el derly patients, we identified several factors that might help both in case selection and in perioperative decisions. (C) 1998 by The Society of Thorac ic Surgeons.