Cardiac surgery in the elderly

Objective: There has been a gradual increase in the number of elderly patie nts referred for cardiac surgery. These patients present a difficult challe nge, they are usually symptomatic yet at high risk for intervention. The ai m of this study is to review our experience with cardiac surgery in patient s aged 80 years or older. Patients and methods: Between January 1981 and Oc tober 1997, 242 patients; 135 female, 107 male, mean age 82.8 years (range 80-95) underwent surgery on cardiopulmonary bypass in our unit. Surgery was performed on 14 as an emergency and 136 on an urgent (patient restricted t o a hospital bed due to symptoms) basis. Pre-operatively 182 (75.2%) were i n NYHA functional class 3 or 4. Results: Early mortality was 14 (5.7%). A m itral valve procedure and emergency surgery were significantly associated ( P < 0.05) with an increased risk of operative mortality. Median ITU and in- hospital stay was 1 day (range 0-33) and 10 (range 6-49) days, respectively . Ninety-three percent of patients were living independently at home 2 mont hs post-operatively. Survival (+/-SEM) is 98% complete (totals 557 patient years) and including early mortality at 1 and 5 years was 85.5 +/- 2.4% (n = 154), and 67.7 +/- 4.3% (n = 33). Survival for patients undergoing isolat ed aortic valve replacement (AVR) and coronary artery bypass grafting (CABG ) at 5 years was 64.8 +/- 7.8% and 79.7 +/- 7.4%, respectively. Survival wa s significantly worse in patients undergoing a mitral procedure. Using Cox' s proportional hazards model only type of operation (mitral surgery) was si gnificantly associated with worse survival. Conclusion: Cardiac surgery can be performed in a selected elderly population with a low operative, mortal ity. Post-operatively elderly patients attain an excellent quality of life and survival. Emergency and mitral surgery in this group of patients is les s rewarding. (C) 1999 Elsevier Science B.V. All rights reserved.