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Updated: Apr 26, 2026

Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy
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Nonagenarians undergoing cardiac surgery.

John P Davis1, Damien J LaPar, Ivan K Crosby

  • 1Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.

Journal of Cardiac Surgery
|July 22, 2014
PubMed
Summary

Cardiac surgery outcomes for nonagenarians show higher mortality than predicted, especially after aortic valve operations. Current risk scores may underestimate the impact of extreme age on patient survival.

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Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Surgical Outcomes

Background:

  • Increasing life expectancy leads to more nonagenarians undergoing cardiac surgery.
  • Limited data exists on surgical outcomes in this extreme elderly population.
  • This study addresses the gap in knowledge regarding nonagenarian cardiac surgery.

Purpose of the Study:

  • To examine contemporary cardiac surgical outcomes in nonagenarian patients.
  • To determine the impact of extreme age on current risk assessment models.
  • To identify specific procedures associated with higher mortality in this cohort.

Main Methods:

  • Analysis of a statewide Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database (2002-2012).
  • Inclusion of 108 nonagenarian patients (age >90 years) in the study cohort.
  • Evaluation of patient factors and operative data, including STS Predicted Risk of Mortality (PROM).

Main Results:

  • Nonagenarians (median age 92) presented with high rates of cerebrovascular disease (23.1%) and arrhythmia (55.6%).
  • Coronary artery bypass grafting (CABG) was the most common procedure (39.8%), followed by aortic valve replacement (AVR) (35.2%).
  • Overall nonagenarian mortality was 13%, with highest rates observed after AVR. Observed to expected mortality ratios ranged from 1.45 to 2.65.

Conclusions:

  • Nonagenarians represent a high-risk group with increased perioperative morbidity.
  • Aortic valve operations are associated with the highest mortality in this age group.
  • Current risk prediction models may underestimate mortality risk in extreme elderly patients.