CARDIAC OPERATIONS IN PATIENTS 80 YEARS OLD AND OLDER

Background. Because the elderly are increasingly referred for operatio n, we reviewed results with cardiac surgical patients 80 years old or older. Methods. Records of 600 consecutive patients 80 years old or ol der having cardiac operations between 1985 and 1995 were reviewed. Fol low-up was 99% complete. Results. Two hundred ninety-two patients had coronary grafting (CABG), 105 aortic valve replacement (AVR), 111 AVR + CABG, 42 mitral valve repair/ replacement (MVR) +/- CABG, and 50 oth er operations. Rates of hospital death, stroke, and prolonged stay (> 14 days) were as follows: CABG: 17 (5.8%), 23 (7.9%) and 91. (31.2%); AVR: 8 (7.6%), 1 (1.0%), and 31 (29.5%); AVR + CABG: 7 (6.3%), 12 (10. 8%), and 57 (51.4%); MVR +/- CABG: 4 (9.5%), 3 (7.1%), and 16 (36.1%); other: 9 (18.0%), 3 (6.0%), and 23 (46.0%). Multivariate predictors ( p < 0.05) of hospital death were chronic lung disease, postoperative s troke, preoperative intraaortic balloon and congestive heart failure; predictors of stroke were CABG and carotid disease; and predictors of prolonged stay were postoperative stroke and New York Heart Associatio n class. Actuarial 5-year survival was as follows: CABG, 66%; AVR, 67% AVR + CABG, 59% MVR +/- CABG, 57%; other, 48%; and total, 63%. Multiv ariate predictors of late death were renal insufficiency, postoperativ e stroke, chronic lung disease, and congestive heart failure. Eighty-s even percent of patients believed having a heart operation after age 8 0 years was a good choice. Conclusions. Cardiac operations are success ful in most octogenarians with increased hospital mortality, postopera tive stroke, and longer hospital stay. Long-term survival is largely d etermined by concurrent medical diseases. (C) 1997 by The Society of T horacic Surgeons.