Cardiac surgery in octogenarians - The Green Lane Hospital experience 1995-1998

Background: An increasing number of patients aged 80 years and over are bei ng considered and accepted for cardiac surgery. Aim: To review the experience of surgery in this elderly group of patients at our institution. Methods: Hospital records of octogenarians undergoing surgery between Janua ry 1995 and September 1998 were reviewed and follow-up was obtained by gene ral practitioner (GP) and patient questionnaires. Results: Thirty-seven patients underwent cardiac surgery. The mean age was 82.8 +/- 1.4 years (range 80.8 to 86.2 years). Twenty-three (62%) were male . All were independent pre-operatively with severe symptoms and minor co-ex isting morbidity. All operations were urgent except two (emergency). Twenty patients (54%) had isolated coronary surgery, six (16%) aortic valve repla cement alone, and 11 (30%) combined surgery. There were four (11%) early de aths and five (14%) peri-operative neurological events. The mean duration o f post-operative intensive care stay was 2.4 +/- 3.9 days (range 0.05 to 16 , median 1.0) and post-operative hospital stay 14.0 +/- 13.9 days (range 0 to 79, median 11). At the time of follow-up (mean duration 20.0 +/- 11.2 mo nths) two further patients had died (non-cardiac). Twenty-six of the 31 sur vivors were living at home (23 independently), one with relatives, and four in residential care. Their cardiac symptoms were well controlled. The GPs of all hospital survivors, and all surviving patients themselves, felt that cardiac surgery had been beneficial. Conclusions: Cardiac surgery in the very elderly has been reserved for thos e with severe disease or symptoms and little co-morbidity. Early mortality is higher than for the general population undergoing cardiac surgery, but p ost-operative resource use is acceptable and the intermediate-term outcome for survivors is good.