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Early and long-term results of cardiovascular surgery in octogenarians
O Shigemitsu1, T Hadama, S Miyamoto
1Emergency Center and Cardiovascular Surgery, Oita Medical University, Hasama-machi, Oita 879-5593, Japan.
Insights
Cardiovascular surgery in octogenarians (patients over 80) shows favorable outcomes, especially for those under 85 without significant comorbidities. Careful patient selection is key for successful cardiac surgery in this age group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Outcomes Research
Background:
- Octogenarians represent a growing population undergoing complex medical procedures.
- Cardiovascular surgery in elderly patients presents unique challenges and risks.
- Understanding outcomes in this demographic is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the characteristics and outcomes of octogenarians undergoing cardiovascular surgery with cardiopulmonary bypass.
- To identify predictors of early, hospital, and late mortality in this patient cohort.
- To assess the postoperative autonomy and quality of life (QOL) in surviving octogenarians.
Main Methods:
- Retrospective analysis of 31 consecutive octogenarian patients undergoing cardiovascular surgery.
- Procedures included coronary artery bypass grafting, valve replacement, and graft replacement.
- Multivariate analyses were used to identify predictors of mortality and postoperative autonomy.
Main Results:
- The early mortality rate was 16.1%, with 5-year survival at 64%.
- Predictors of early mortality included preoperative left ventricular ejection fraction.
- Preoperative renal dysfunction, intraaortic balloon pumping, and age predicted hospital death; chronic lung disease and age predicted late mortality.
- Diabetes mellitus and fewer bypass grafts were risk factors for postoperative autonomy.
- Many patients achieved autonomy and improved QOL post-surgery.
Conclusions:
- Cardiovascular surgery can yield favorable long-term outcomes in selected octogenarians (<85 years) without significant comorbidity.
- Individualized treatment recommendations are necessary for octogenarians over 85 or with comorbidities, balancing surgical risks and life expectancy.
- Postoperative quality of life significantly improves compared to the preoperative state.
Abstract:
The purpose of this study was to evaluate characteristics and outcomes of octogenarians undergoing cardiovascular surgery with cardiopulmonary bypass in a Japanese population. Thirty-one consecutive patients over 80 years of age underwent coronary artery bypass grafting 19 (61%), combined coronary artery bypass grafting and ventricular septal perforation closure 1 (3%), valve replacement 3 (10%), and prosthetic graft replacement 8 (26%). The early mortality rate was 16.1%. Survival estimates were 74% after 1 year, 74% after 3 year, and 64% after 5 years. Emergency and urgent cases involved 16 (51.6%), and 2 patients (6.5%), respectively. Multivariate analyses revealed that predictors of early mortality was preoperative left ventricular ejection fraction. Predictors of hospital death (within 3 months after surgery) were preoperative renal dysfunction, intraaortic balloon pumping, and age. Predictors of late mortality were chronic lung disease and age. Twenty-one patients expected to have died before surgery were living at home, and 9 (40.9%) patients were completely autonomous. Multivariate analyses revealed diabetes mellitus and a small number of bypass grafts were predictive risk factors for postoperative autonomy. Thus, cardiovascular surgery can be performed in octogenarians under 85 years of age with a favorable long-term outcome, when appropriately applied in selective octogenarians without significant comorbidity. If patients are over 85 years of age or have significant comorbidity, clinical treatment recommendations should be individually tailored while evaluating the risk of having or not having surgery and their life expectancy. QOL of survivors was almost satisfactory and significantly improved compared with a preoperative state.