Cardiac surgery in nonagenarians: hospital mortality and long-term follow-up

Nonagenarians represent a growing part of the population. However, it is assumed that they present a poorer functional class to cope with the stress inferred by surgical interventions. The aim of this study was to review our experience with nonagenarians concerning postoperative morbidities, mortality, and long-term survival status. Retrospective data from 30 consecutive nonagenarians who underwent cardiac surgery between January 1990 and December 2002, and their long-term follow-up was analysed. There were 18 women (60%) and 11 men. Left ventricle ejection fraction (LVEF) was 50.3+/-10.5%. Fifty percent of the patients were in NYHA functional class III or IV. There were nine coronary artery bypass grafting (CABG) procedures (30%), 16 aortic valve replacements (AVR), (53%), one double valve procedure and one replacement of infected intracavitary pace-maker leads. In-hospital mortality rate was 20% (6/30). Mean follow-up was 21.5+/-19 months (r: 2.2 to 68). Actuarial survival rate at 12, 24 and 60 months was 67%, 43% and 30%, respectively. Surviving patients referred quality of life as good, all but one were in NYHA functional class I. Nonagenarians undergoing cardiac surgery have higher mortality and morbidity rates than younger patients. However, in a carefully selected group of patients, the operative risk remains acceptable.