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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.
Insights
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.
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.
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.
Abstract:
The increasing safety of cardiac surgery has led to the frequent referral of octogenarians for operation. Between 1980 and 1989, we reviewed our experience with 103 octogenarians (59 male, 44 female; mean age 82 years) to determine the surgical risk factors and outcome in the elderly population. There were 71 coronary bypasses (CABG), 11 aortic valve replacements (AVR), 11 AVR-CABG, 4 mitral valve replacements (MVR), 3 MVR-CABG and 3 AVR-MVR-CABG. Seventeen patients died during hospitalization (16.5%) including 9 CABG (13%); 1 AVR (9%), 2 AVR-CABG (18%), 2 MVR (50%), 1 MVR-CABG (33%) and 2 AVR-MVR-CABG (67%). Statistical analysis of 22 perioperative variables suggested that a preoperative intraaortic balloon, a history of congestive heart failure, mitral valve replacement, urgent operation, need for preoperative inotropic support and the number of anastomoses performed were significant or marginally significant (P less than 0.15) univariate predictors of operative mortality. Multivariate analysis revealed that the need for a preoperative intraaortic balloon (F = 13.1), history of congestive heart failure (F = 6.8), and MVR (F = 6.7) were significant (P less than 0.001) independent predictors of mortality. Postoperative complications included arrhythmias in 36 patients (35%), respiratory insufficiency in 11 (11%), reversible neurological deficit in 15 (14%), and a permanent neurological deficit in 6 patients (6%). Actuarial survival was 90% and 82% at 1 and 2 years, respectively. Seven of 86 (8%) long term survivors sustained a stroke in the follow-up interval. The mean follow-up of survivors was 23 +/- 19 months with a mean improvement in NYHA class of 1.4 (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)