Good outcomes from cardiac surgery in the over 70s

Objective-To determine the early mortality and major morbidity associated w ith cardiac surgery in the elderly. Design-Retrospective case record review study of 575 patients greater than or equal to 70 years old who underwent cardiac surgery at the Manchester He art Centre between January 1990 and December 1996. Setting-Regional cardiothoracic centre. Subjects-Patients b 70 years old who underwent cardiac surgery. Main outcome measures-Comparison of 30 day mortality and incidence of major morbidity between patients greater than or equal to 70 years old and patie nts < 70 years old. Results-Of 4395 cardiac surgical operations, 575 operations (13.1%) were in patients aged greater than or equal to 70 years (mean (SD) 73.1 (3.2) year s). The proportion of elderly patients rose progressively from 7.9% in 1990 to 16.5% in 1996. 334 patients (58.1%) had coronary artery bypass grafting alone, 91 patients (15.8%) had valve surgery alone, and 129 patients (22.4 %) had combined valve surgery and bypass grafting. For isolated coronary ar tery bypass grafting, 30 day mortality in patients greater than or equal to 70 years was 3.9% compared with 1.3% in patients < 70 years (p < 0.001). 3 0 day mortality for isolated valve surgery in patients greater than or equa l to 70 years was 7.7%. Isolated aortic valve replacement was the most comm on valvar procedure in patients greater than or equal to 70 years and carri ed the lowest mortality (4.3%). Additional coronary artery bypass grafting increased the mortality rate in patients greater than or equal to 70 years to 9.3% for all valve surgery and to 8.0% for aortic valve replacement. Maj or morbidity in patients greater than or equal to 70 years was low for all procedure types (stroke 1.9%, acute renal failure requiring dialysis 1.6%, perioperative myocardial infarction 0.5%). Conclusions-Early mortality and major morbidity is low for cardiac surgery in elderly patients. Concerns over the risk of cardiac surgery in the elder ly should not prevent referral, and elderly patients usually do well. Howev er, unconscious rationing of health care may affect referral patterns, and studies that assess the cost effectiveness of cardiac surgery versus conser vative management in such patients are lacking.