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Published on: August 11, 2015
Cardiac surgery in patients over the age of 80 years
T T Bashour1, E S Hanna, R K Myler
1San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015.
Insights
Open heart surgery in octogenarians has a 12.5% operative mortality, with higher risks for those in poor functional class or with specific complications. However, selected elderly patients with severe heart disease may still benefit from surgical intervention.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Thoracic Surgery
Background:
- The risk-benefit profile of cardiac operations in octogenarians remains incompletely defined.
- Elderly patients present unique challenges in cardiac surgery due to comorbidities and frailty.
Purpose of the Study:
- To evaluate the outcomes and identify risk factors for operative mortality in patients over 80 undergoing cardiac surgery.
- To inform clinical decision-making regarding surgical intervention for octogenarians with severe cardiac conditions.
Main Methods:
- Retrospective analysis of 80 consecutive octogenarian patients undergoing cardiopulmonary bypass for various cardiac procedures.
- Data collected included patient demographics, functional class, surgical procedure, and operative outcomes.
Main Results:
- Overall operative mortality was 12.5%.
- Mortality was associated with advanced functional class, mitral valve replacement, postoperative hemorrhage, and pulmonary disease.
- Common causes of death included bleeding, left ventricular failure, and arrhythmias.
Conclusions:
- While a conservative approach is often warranted, selected octogenarians, particularly those without significant multisystem disease, can benefit from open heart surgery.
- Careful patient selection is crucial to optimize outcomes in this high-risk population.
Abstract:
The risk-benefit relationship of open heart surgery in octogenarians is not well established. Eighty consecutive patients over the age of 80 who underwent cardiac operations under cardiopulmonary bypass were evaluated. Twenty-five patients were in functional class IV, 42 in class III, and 13 in class II. Forty-four patients had only coronary artery bypass grafts (CABG), 12 only aortic valve replacement (AVR), 6 only mitral valve replacement (MVR), 12 CABG and AVR, 4 CABG and MVR, 1 CABG and aneurysmectomy, and 1 had resection of left atrial myxoma. Operative mortality (within 30 days) was 12.5% for the group. Mortality was related to bleeding, left ventricular failure, primary ventricular fibrillation, pulmonary failure, and renal failure. Mortality was higher in patients with (1) advanced functional class, (2) mitral valve replacement, (3) postoperative hemorrhage, and (4) associated pulmonary disease. While a generally conservative approach is recommended for octogenarian patients, many with life-threatening cardiac disease, especially those free of major multisystem illnesses, should not be denied the benefit of surgical treatment.
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