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Open-heart surgery in octogenarians.

L H Edmunds1, L W Stephenson, R N Edie

  • 1Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia 19104.

The New England Journal of Medicine
|July 21, 1988
PubMed
Summary
This summary is machine-generated.

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Open-heart operations can be effective for selected octogenarians with severe cardiac symptoms. While early mortality exists, long-term survival is promising, with most survivors experiencing improved functional status.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Open-heart surgery in octogenarians (patients 80 years and older) presents unique challenges due to age-related comorbidities.
  • Historically, advanced age has been a contraindication for complex cardiac procedures, leading to undertreatment of severe cardiac conditions in this population.

Purpose of the Study:

  • To evaluate the safety and efficacy of open-heart operations in octogenarian patients.
  • To identify preoperative factors associated with early mortality and long-term survival.
  • To assess the functional outcomes and quality of life after cardiac surgery in this elderly cohort.

Main Methods:

  • A retrospective review of 100 consecutive octogenarian patients undergoing open-heart operations between July 1976 and May 1987.

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  • Analysis of patient demographics, cardiac diagnoses (aortic valvular disease, coronary artery disease, mitral valvular disease), New York Heart Association (NYHA) functional class, and indications for surgery.
  • Evaluation of early postoperative outcomes (mortality, complications) and long-term survival, including functional status at follow-up.

    • Main Results:

    • Twenty-nine patients (29%) died within 90 days of operation. Preoperative factors associated with early death included NYHA Class IV disease, previous myocardial infarction, cachexia, and emergency operation.
    • Forty-three patients had no complications other than atrial arrhythmias and were discharged in a mean of 11.5 days.
    • Among survivors, common serious complications included low cardiac output, myocardial infarction, bleeding requiring reoperation, renal insufficiency, pneumonia, and prolonged intubation.
    • Long-term actuarial survival was predicted at 59% at three years and 54% at five years.
    • Of the 54 surviving patients, 53 had improved functional status (NYHA Class I or II).

    Conclusions:

    • Open-heart surgery is a viable therapeutic option for carefully selected octogenarian patients with severe, unmanageable cardiac symptoms.
    • Despite significant early risks, a substantial proportion of octogenarian survivors experience long-term benefit and improved functional capacity.
    • Risk stratification and patient selection are crucial for optimizing outcomes in this elderly surgical population.