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Outcome following open-heart surgery in an Oriental octagenarian population in Hawaii
1Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu 96813.
Insights
Open-heart surgery is safe for high-risk octogenarians with heart disease, showing significant functional improvement. This study reviewed outcomes for elderly patients undergoing cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Surgical management of ischemic or valvular heart disease is increasingly used in elderly patients.
- Octogenarians represent a high-risk demographic for cardiac surgery.
Purpose of the Study:
- To evaluate the safety and outcomes of open-heart surgery in octogenarians.
- To assess functional improvement in elderly patients undergoing cardiac procedures.
Main Methods:
- Retrospective review of octogenarian patients undergoing open-heart surgery over a 2-year period.
- Analysis of patient demographics, surgical urgency, preoperative support, postoperative complications, and functional status.
Main Results:
- Thirteen octogenarians (mean age 82.6 years) underwent surgery.
- 10 patients required emergency surgery, and 6 needed intra-aortic balloon counterpulsation (IABP).
- 11 patients experienced postoperative complications, including atrial arrhythmias and low cardiac output.
- Significant functional improvement was observed, with New York Heart Association (NYHA) classification improving from 3.8 to 1.5 (p < 0.001).
- All patients survived with a mean follow-up of 13.3 months.
Conclusions:
- Open-heart surgery can be performed safely in high-risk octogenarian populations.
- Cardiac surgery leads to statistically significant functional improvement in elderly patients.
- This approach offers a viable option for managing heart disease in the oldest patient groups.
Abstract:
Increasingly, a surgical approach is being utilized for the management of elderly patients with ischemic or valvular heart disease. In order to further understand the outcome in this population, we performed a retrospective review of octagenarians undergoing open-heart surgery over a 2-year period. Thirteen patients were identified, with a mean age of 82.6 years. All were Oriental. Most of our patients were considered high risk, 10 of them requiring emergency surgery and 6 requiring preoperative intra-aortic balloon counterpulsation (IABP). Postoperatively, 11 of the 13 patients suffered at least 1 complication. The most frequent complications were atrial arrythmias (7 patients), a low cardiac output (5 patients), the need for prolonged ventilation (3 patients) and ventricular arrythmias (3 patients). Functionally, the patients statistically improved, from a mean preoperative classification of 3.8 (New York Heart Association Classification) (NYHA) to 1.5 at the time of discharge (p less than 0.001). All patients are still alive at the time of writing (October 1989) with a mean followup of 13.3 months. Our data show that an operative approach to heart disease can be done safely in a high risk octagenarian population. In addition, we found that a statistically significant functional improvement occurred in these patients.
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