Related Experiment Video
Updated: Jun 17, 2026
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Cardiac surgery in nonagenarians: single-centre series and review
Mathew R Guilfoyle1, Andrew J Drain, Asmatullah Khan
1Papworth Hospital, Cambridge, UK.
Insights
Cardiac surgery in nonagenarians (patients 90 years or older) shows acceptable risks and significant survival benefits. Selected elderly patients experience improved symptoms and longer life expectancy after these procedures.
Area of Science:
- Cardiology
- Geriatric Medicine
- Cardiothoracic Surgery
Background:
- Cardiac surgery is often considered high-risk for very elderly patients.
- Increasing life expectancy necessitates re-evaluation of surgical risks versus benefits in older populations.
Purpose of the Study:
- To evaluate the outcomes of cardiac surgery in nonagenarian patients.
- To challenge the assumption that cardiac surgery is prohibitively risky for the very elderly.
Main Methods:
- Analysis of prospectively collected single-center data.
- Review of published literature on cardiac surgery outcomes in nonagenarians.
Main Results:
- Seventy-three nonagenarians underwent open cardiac surgery between 1998-2007.
- Pooled surgical mortality was 12.7%, with significant symptomatic improvement and survival benefit observed.
- Actuarial survival at 1 and 5 years was 72% and 54%, respectively, with a standardized mortality ratio of 0.57 compared to life tables.
Conclusions:
- Cardiac surgery in selected nonagenarians is associated with acceptable morbidity and early mortality.
- These patients experience significant symptomatic relief and a survival benefit post-surgery.
- The findings support reconsidering cardiac surgery for elderly patients who may benefit.
Background:
Cardiac surgery is widely believed to be an excessively high-risk intervention for very elderly patients with coronary artery or valvular disease. However, as life expectancy and the prospect of sustained quality of life into older age increase, this assumption should be challenged so that surgery is not denied to patients who may derive significant symptomatic benefit with acceptable levels of operative risk.
Objective:
To evaluate outcomes from cardiac surgery in nonagenarian patients.
Design:
Analysis of prospectively collected single-centre data and review of outcomes reported in the literature.
Results:
Twenty-three patients (13 males) aged 90 years or more underwent open cardiac surgery between 1998 and 2007. Four patients died within 30 days of surgery (surgical mortality 17.4%) and all-cause in-hospital morbidity was 74%. Actuarial survival at 1 and 5 years was estimated at 72 and 54%, respectively. Comparison of patients' survival against age-matched life tables for the English population found a standardised mortality ratio of 0.57 (95% CI: 0.24-0.99; one-sample log-rank test chi(2) = 3.93; p < 0.05) representing a significant survival benefit associated with surgery. The majority of patients reported symptomatic improvement reflected by significant decreases in angina and dyspnoea scores. Six single-centre series of nonagenarians and 3 reviews from national databases in the US and UK were identified in the literature. Pooled surgical mortality was 12.7% (95% CI: 8.7-17.3%) with no significant heterogeneity (chi(2) = 4.12; p = 0.77; I(2) = 0).
Conclusion:
Cardiac surgery in the elderly carries higher operative risk than in younger patients. However, in selected nonagenarians, surgery can be performed with acceptable morbidity and early mortality, and patients gain significant symptomatic relief and survival benefit.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Cardiomyopathy V: Interprofessional Care