[Anesthetic management of elderly patients in open heart surgery]

In the National Cardiovascular Center, 46 patients whose ages were above 70 underwent open heart surgery from 1977 to 1986. Twenty of them received AC bypass and 5 had repair of the rupture of ventricular septum or left ventricular aneurysm. Among them 2 had also insertion of left ventricular assist device because of acute myocardial infarction (MI). Eighteen underwent mitral and/or aortic valve replacement. The other 3 were operated on because of atrial myxoma etc. Preoperatively, in ischemic heart disease group, due to resultant heart failure, one third of the patients were given catecholamines. In valvular heart disease group, angina pectoris and old MI were also common. Beside arrhythmias, respiratory complications, renal dysfunction and diabetes mellitus, neurological complications such as brain infarction were prominent in both groups. Hospital mortality was 15% in AC bypass group, 40% in acute MI group and 11.1% in VHD group. In 36 patients who left hospital, mean NYHA class improved after operation. The mortality rate and symptomatic improvement demonstrate that cardiac surgery can be performed with acceptable risk in elderly patients. Anesthesiologists should manage them carefully, considering the problems stated above.