Cardiac reoperations in octogenerians

Objective: In recent years, satisfactory outcome of primary cardiac operati on in octogenarians and increased ageing of cardiac surgical population in western hospitals have led to increased expectations and referrals for reop eration. Outcome of reoperation in this aged subset was analysed. Methods: Consecutive 18 octogenerians (mean age 81.2 years, 10 men, eight women) und ergoing cardiac reoperations from November 1989 through August 1998 were re trospectively reviewed. Results: They represented 6.2% of all octogenerian cardiac surgical patients and 2.7% of all reoperations during the same peri od. Mean preoperative NYHA class was 3.4 and Parsonnet score was 29.4. The interval to reoperation was 114.5 +/- 11.96 (4-188) months. Priority was ur gent in 11 and elective in seven patients. The procedures included four AVR s, five MVRs (including two associated TVAs), six CABGs and one each of MVR with CABG, AVR with CABG and AVR, MVR and CABG. Average graft/patient was 2.3. Mean ICU stay was 4.6 +/- 1.5 (1-28) days. There was one hospital deat h (5.5%) on 18 pod after MVR in an 83-year-old woman. Mean postoperative st ay was 20.2 +/- 5.13 (8-93) days. There were three late deaths (17.6%) - at 32 months after MVR, at 44 and 63 months after CABG. Long-term survivors w ere 90% among men and 50% among women who were followed up for 42.7 +/- 6.9 (9-93) months. Mean Karnofsky score in survivors at 1 year of follow-up wa s 78.5 +/- 2.9. Despite continued medication in all survivors, mean current NYHA is 1.9 and most have improved lifestyle. Conclusions: Satisfactory ou tcome may be expected after cardiac reoperations in highly selected octogen erians. However, increased procedural risks, complications, hospital stay a nd slower convalescence during early follow-up may be anticipated, and will indicate very careful screening. These results indicate a need to reconsid er the treatment policy in primary operation with regard to choice of graft conduits and prosthetic valves in other elderly patients. (C) 1999 Elsevie r Science B.V. All rights reserved.