[Cardiac surgery in the octogenarian]

Progressive ageing of the population results in an increased number of patients in their eighties referred for cardiac surgery. The combination of the effects of ageing and age-related diseases makes eighty-year-olds a group of high-risk surgical patients. Due to the increasingly limited resources of health care systems, the results of cardiac surgery in eighty-year-olds must be re-evaluated in terms of survival and postoperative quality of life. A review of the international literature concerning coronary, aortic and mitral valve surgery in eighty-year-olds suggests that the postoperative complication rate, the duration of intensive care and the early postoperative mortality are significantly higher than in younger subjects. However, the long-term survival probability is similar to that of a population of eighty-year-olds without heart disease and significantly better than after non-surgical treatment. The quality of life is usually improved by the operation as suggested by a significant reduction of the symptoms and improvement of functional capacities. The favourable long-term results of cardiac surgery in eighty-year-olds therefore compensate for the higher intraoperative risk and argue in favour of earlier intervention.