Pre and perioperative factors determining early in-hospital mortality in patients over 75 years of age undergoing cardiac surgery

Objectives. To know the in-hospital morbidity and mortality and the related factors in patients over 75 years old undergoing cardiac surgery. Patients and methods. A retrospective analysis was carried out in 252 out o f 2043 consecutive patients (129 female, 123 male) over 75 years of age (me an age 77.8 years; range 75 to 89 years) undergoing open heart surgery from January 1, 1994 to November 30, 1997. Isolated aortic valve replacement wa s performed in 128 patients, 78 underwent isolated coronary artery bypass g rafting and 46 combined surgery. Preoperative determinants of morbidity and mortality were analyzed. Results. The overall hospital mortality was 15.1%, 13.2% in the aortic grou p, 12.8% in the coronary group and 23.9% in the combined surgery group. The overall morbidity rate was 38.6% and 25.8%, 34.2% in the aortic and corona ry groups, respectively. Preoperative risk factors were prior surgery (p < 0.0004) and emergency operation (p < 0.04). In aortic valve replacement, NY HA class IV (p < 0.05), prior operation (p < 0.01) and emergency surgery (p < 0.01) were determinant. Perioperative factors of early mortality were: p rolonged cross-clamping > 60 min (p < 0.02), cardiopulmonary bypass time > 90 min (p < 0.002), need for inotropic drugs (p < 0.005) and postoperative complications (p < 0.00001). Mean postoperative length of hospital stay was 12.8 <plus/minus> 8.5 days. Conclusions. Despite the greater rate of early morbi-mortality in patients over 75 years of age, cardiac surgery may be performed avoiding emergency s urgery, functional grade IV and prolonged length of surgery.