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Nonelective cardiac surgery in the elderly: is it justified?

Ravi K Ghanta¹, Prem S Shekar, Siobhan McGurk

¹Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 02115, USA.

The Journal of Thoracic and Cardiovascular Surgery

|December 17, 2009

Summary

Elderly patients over 80 can achieve good long-term survival and quality of life after nonelective cardiac surgery. Age should not be a barrier to urgent or emergent cardiac procedures.

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Area of Science:

Cardiology
Geriatric Medicine
Surgical Outcomes

Background:

Elderly patients (over 80) often face denial of nonelective cardiac surgery due to perceived poor outcomes and quality of life.
This perception may lead to undertreatment of critical cardiac conditions in this demographic.

Purpose of the Study:

To evaluate the long-term survival and quality of life in patients aged 80 and above who underwent nonelective cardiac surgery.
To determine if age alone should be a contraindication for urgent or emergent cardiac procedures.

Main Methods:

A cohort of 262 patients over 80 underwent urgent or emergent cardiac surgery between 1994 and 1999.
Procedures included coronary artery bypass grafting (CABG), CABG plus valve surgery, valve surgery, and aortic surgery.
Kaplan-Meier survival analysis, quality-of-life assessments, and Cox regression for mortality risk factors were employed. Risk scores (Society of Thoracic Surgeons, EuroSCORE) were assessed.

Main Results:

Overall early mortality was 11%, with higher rates in emergent (33%) versus urgent (7%) cases.
Five-year survival was 50% overall, and 10-year survival for urgent cases matched age-adjusted population data.
Survivors reported quality of life equivalent to the general elderly population. Risk factors for mortality included age, emergent status, and specific complications.

Conclusions:

Nonelective cardiac surgery in patients over 80 can yield long-term survival and quality of life comparable to the general elderly population.
Age should not be an absolute contraindication for urgent or emergent cardiac surgery in this age group.