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Combined cardiac surgical procedures in octogenarians: operative outcome
Insights
Cardiac surgery in octogenarians is increasing. Combined procedures in patients aged 80+ had higher mortality (9.3%) and resource needs but lower-than-predicted mortality, justifying careful patient selection.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- The number of patients aged 80 and over requiring cardiac surgery is rising.
- This study retrospectively analyzes single-center outcomes of combined and redo cardiac surgical procedures in octogenarians.
Purpose of the Study:
- To evaluate the outcomes of combined cardiac surgical procedures in octogenarians.
- To compare these outcomes with a younger control group.
Main Methods:
- Retrospective analysis of 236 octogenarians undergoing combined cardiac surgery (aortic valve replacement + aorto coronary bypass or double valve replacement) and 124 younger controls.
- Risk stratification using additive and logistic Euro-score.
- Statistical comparison using t-test and Chi-square test.
Main Results:
- Observed mortality in octogenarians was 9.3%, with re-intubation and double valve replacement (DVR) as risk factors.
- Octogenarians had higher mortality (10% vs. 4%), increased need for hemodialysis (16.3% vs. 4.9%), and higher incidence of postoperative psycho-syndromes compared to controls.
- Euro-score overestimated actual mortality in all groups.
Conclusions:
- Octogenarians undergoing combined cardiac surgery require more resources and have higher in-hospital mortality than younger patients.
- Observed mortality was lower than predicted, supporting surgical intervention in carefully selected octogenarians.
- Euro-score alone is insufficient for predicting outcomes; patient selection is crucial.
Introduction:
The number of patients with an indication for cardiac surgery in their ninth decade of life is increasing. This study analyses the single-center results with combined and redo cardiac surgical procedures in octogenarians retrospectively.
Patients And Methods:
Three groups were evaluated: (I) Two hundred and thirty six patients with combined cardiac surgical procedures, mean age 83.1 +/- 2.5 years, 107 male (129 female). Combined aortic valve replacement (AVR) and aorto coronary bypass (ACB) was done in 215, double valve replacement (DVR) in 21. (II) AVR + ACB-group: 215 patients out of group I. (III) Control group consisting of 124 patients with a mean age of 74.1 +/- 2.8 years (range 70-79.9 years) who received combined AVR and ACB. Risk stratification was done using the additive and logistic Euro-score; values are given as mean +/- standard deviation and were compared using either the t-test or the Chi-square test.
Results:
The observed mortality in group I was 9.3%. Re-intubation was observed in 10.2% and was one major risk factor for in-hospital mortality. As second risk factor, DVR could be identified. 14.8% required hemodialysis postoperatively, but this affected only the length of stay on intensive care unit (ICU) but not mortality. When comparing group II with group III, mortality was higher (10% vs. 4%), the need for hemodialysis was more frequent (16.3% vs. 4.9%), and the incidence of postoperative psycho-syndromes was also higher (26% vs. 8.1%, all: P < 0.05). The duration of ventilation (2.7 +/- 7.7 vs. 1.6 +/- 4.3 days) and the length of stay on ICU (8.2 +/- 8.8 vs. 5.7 +/- 6.4) were longer without reaching statistical significance (P > 0.05). The Euro-score overestimated the real mortality in all groups.
Conclusions:
Octogenarians requiring combined cardiac surgical procedures required more resources and had a higher in-hospital mortality compared to younger patients. The observed in-hospital mortality was much lower than the predicted justifying the indication for surgical therapy in these patients. Patient selection, however, seems to be important but the Euro-score alone was rather ineffective in predicting poor outcome.
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