Outcomes of cardiac surgery in patients age >= 80 years: Results from the National Cardiovascular Network

OBJECTIVES The purpose of this study was to evaluate characteristics and ou tcomes of patients age greater than or equal to 80 undergoing cardiac surge ry. BACKGROUND Prior single-institution series have found high mortality rates in octogenarians after cardiac surgery. However, the major preoperative ris k-factors in this age group have not been identified. In addition, the addi tive risks in the elderly of valve replacement surgery at the time of bypas s are unknown. METHODS We report in-hospital morbidity and mortality in 67,764 patients (4 ,743 octogenarians) undergoing cardiac surgery at 22 centers in:the Nationa l Cardiovascular Network. We examine the predictors of in-hospital mortalit y in octogenarians compared with those predictors in younger patients. RESULTS Octogenarians undergoing cardiac surgery had fewer comorbid illness es but higher disease severity and surgical urgency than younger patients.: Octogenarians had significantly higher in-hospital mortality after cardiac surgery than younger patients: coronary artery bypass grafting (CABG) only (8.1% vs. 3.0%), CABG/aortic valve (10.1% vs. 7.9%), CABG/mitral valve (19 .6% vs. 12.2%). In addition, they had twice the incidence of postoperative stroke and renal failure. The preoperative clinical factors-predicting CABG mortality in the very elderly were quite similar to those for younger pati ents with:age, emergency surgery and prior CABG being the powerful predicto rs of outcome in both age categories. Of note, elderly patients without sig nificant comorbidity had in hospital mortality rates of 4.2% after CABG, 7% after CABG with aortic valve replacement (CABG/AVR), and 18.2% after CABG with mitral valve replacement (CABG/MVR). CONCLUSIONS Risks for octogenarians undergoing cardiac surgery are less tha n previously reported, especially for CABG only or CABG/AVR. In selected oc togenarians without significant comorbidity, mortality approaches that seen in younger patients. (C) 2000 by the American College of Cardiology.