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601 octogenarians undergoing cardiac surgery: outcome and comparison with younger age groups
J M Craver1, J D Puskas, W W Weintraub
1Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Cardiac surgery in octogenarians shows acceptable in-hospital mortality and good 5-year survival rates. While initial outcomes are comparable to younger groups, long-term survival declines more rapidly in patients over 80.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Cardiac valve replacement and coronary artery bypass graft surgery (CABG) are increasingly performed in patients aged 80 and older.
- Octogenarians undergoing cardiac surgery often present with more severe comorbidities compared to younger patients.
Purpose of the Study:
- To assess the short- and long-term survival outcomes of octogenarians undergoing cardiac surgery.
- To compare the outcomes of octogenarians with younger patient cohorts (60-69 and 70-79 years).
Main Methods:
- Retrospective study of 601 consecutive patients over 80 years old undergoing cardiac surgery between 1976 and 1994.
- Comparison with 11,386 patients aged 60-69 and 5,698 patients aged 70-79 undergoing similar procedures.
Main Results:
- Octogenarians had higher rates of female gender, class IV angina, and congestive heart failure class IV.
- In-hospital mortality (9.1%) and stroke rates (5.7%) were higher than in the 60-69 age group but only slightly increased compared to the 70-79 age group.
- Median 5-year survival was 55% for octogenarians, compared to 69% for 70-79 year olds and 81% for 60-69 year olds.
Conclusions:
- Cardiac surgery can be safely performed in selected octogenarians with acceptable mortality.
- Excellent 5-year survival rates are achievable in this elderly population.
- Careful patient selection is crucial for optimizing outcomes in octogenarian cardiac surgery.
Background:
Cardiac valve replacement and coronary artery bypass graft surgery (CABG) are being applied with increasing frequency in patients 80 years of age and older.
Methods:
Six hundred one consecutive patients older than 80 years, undergoing cardiac surgery between 1976 and 1994 (CABG with saphenous vein graft, 329 [54.7%]; CABG with left internal mammary artery, 101 [16.8%]; CABG + valve, 80 [13.3%]; isolated aortic valve replacement, 71 [11.8%]; isolated mitral valve replacement, 18 [3.0%]), were studied retrospectively to assess short- and long-term survival. They were compared with 11,386 patients aged 60 to 69 years and 5,698 patients aged 70 to 79 years undergoing similar procedures during the same time interval.
Results:
In comparison with patients 60 to 69 years old, more octogenarians were women (44.4% versus 25.6%, p<0.0001), had class IV angina (54.1% versus 38.9%, p<0.0001), and had congestive heart failure class IV (4.9% versus 3.0%, p = 0.0001). In-hospital death rates (9.1% versus 3.4%, p<0.0001) and stroke (5.7% versus 2.6%, p<0.0001) reflected these adverse clinical risk factors. However, Q-wave infarction tended to be less frequent (1.5% versus 2.6%, p = 0.102). Interestingly, hospital mortality (9.1% versus 6.7%, p = 0.028) was only slightly increased, and stroke (5.7% versus 4.7%, p = 0.286) was not more common in octogenarians than in patients 70 to 79 years old. Late-survival curves have similar slopes for the first 5 years in all clinical subgroups. However, after 5 years there is a more rapid decline in octogenarians than in younger age groups. Median 5-year survival was 55% for patients older than 80 years, 69% for patients 70 to 79 years, and 81% for patients 60 to 69 years old.
Conclusions:
When appropriately applied in selected octogenarians, cardiac surgery can be performed with acceptable mortality and excellent 5-year survival.