Cardiac surgery in geriatric patients

From June, 1960, to January, 1976, 157 patients 65 years or older had elective operations with cardiopulmonary bypass. Ninety-three patients had one or two valves replaced, 47 had coronary artery surgery, and 17 had both. The operative mortality rate was 22.6 percent (21 of 93), 19.1 percent (nine of 47), and 5.8 percent (one of 17), respectively. The over-all mortality rate was 19.7 percent (31 of 157). The mortality rate of patients of 65 to 69 years of age was 20 percent (22 of 110) and 19 percent (9 of 47) in patients 70 years or more. Ninety-four of these operations were performed within the last 3 years, with a reduction in patients' mortality rate to 9.6 percent (nine of 94). A retrospective study revealed a significant correlation between operative mortality rate and preoperative heart size. We could find no correlation between operative mortality rate and diabetes, smoking history, or hyperlipidemia. The major causes of death were myocardial infarction (68 percent-21 of 31), pulmonary complications (35 percent-11 of 31), infections (29 percent-nine of 31), and renal failure (29 percent-nine of 31) or combinations thereof. The patients who died had 2.5 times the number of complications of the survivors. Ninety percent of our patients in the past 3 years have survived their operation. Therefore, elective cardiac operations can be performed with an acceptable mortality rate in patients over the age of 65 years.