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Cardiac surgery in the octogenarian.

K S Naunheim1, P A Dean, A C Fiore

  • 1Department of Surgery, St. Louis University Medical Center, MO.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1990
PubMed
Summary

Cardiac surgery in octogenarians carries significant risks, with preoperative intraaortic balloon use, congestive heart failure, and mitral valve replacement being key predictors of mortality. Despite risks, long-term survival and functional improvement are achievable for elderly patients undergoing these procedures.

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Area of Science:

  • Cardiovascular Surgery
  • Geriatric Medicine
  • Outcomes Research

Background:

  • Increasing safety of cardiac surgery leads to more octogenarian referrals.
  • Elderly patients present unique challenges and risks in cardiac procedures.

Purpose of the Study:

  • To determine surgical risk factors and outcomes in octogenarian patients undergoing cardiac surgery.
  • Identify predictors of operative mortality in this elderly population.

Main Methods:

  • Retrospective review of 103 octogenarians (mean age 82) between 1980-1989.
  • Analysis included various cardiac procedures: coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve replacement (MVR).
  • Statistical analysis of 22 perioperative variables using univariate and multivariate models to identify mortality predictors.

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Main Results:

  • Overall in-hospital mortality was 16.5%.
  • Significant independent predictors of mortality included preoperative intraaortic balloon use, history of congestive heart failure, and mitral valve replacement (P < 0.001).
  • Common postoperative complications included arrhythmias (35%) and neurological deficits (6% permanent).
  • Actuarial survival was 90% at 1 year and 82% at 2 years.
  • Long-term survivors showed significant functional improvement (mean NYHA class improvement of 1.4).

Conclusions:

  • Cardiac surgery in octogenarians is associated with considerable mortality, influenced by specific preoperative conditions and procedures.
  • Despite risks, a substantial proportion of elderly patients survive and experience improved functional status post-surgery.
  • Risk stratification and careful patient selection are crucial for optimizing outcomes in octogenarian cardiac surgery.