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Cardiac surgery in the octogenarian
Insights
Cardiac surgery in octogenarians (80-89 years) shows significant early mortality (13%) and complications. However, survivors experience functional improvement, supporting timely surgical intervention for selected patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Octogenarians (aged 80-89) represent a growing population undergoing cardiac operations.
- Preoperative functional status, particularly New York Heart Association (NYHA) Class IV, is a critical factor in outcomes.
- The safety and efficacy of cardiopulmonary bypass in this age group require careful evaluation.
Purpose of the Study:
- To evaluate the early and late outcomes of cardiac operations in octogenarians.
- To identify risk factors associated with mortality and morbidity in this patient cohort.
- To assess the functional status improvement in survivors post-cardiac surgery.
Main Methods:
- Retrospective analysis of 76 consecutive octogenarian patients undergoing cardiac operations.
- Procedures included coronary artery bypass grafting (CABG), valve replacement, and combined procedures.
- Data collected on early mortality, postoperative complications, hospital stay, and late cardiac-related deaths.
Main Results:
- Overall early mortality was 13% (10 deaths), with higher rates in combined procedures (30%).
- Major postoperative complications occurred in 29.1% of survivors.
- Risk factors for mortality included NYHA Class IV status, combined procedures, intra-aortic balloon pump use, and reoperation for bleeding.
Conclusions:
- Cardiac surgery in octogenarians can be performed with acceptable outcomes, particularly for isolated coronary artery disease and valve disease.
- Timely surgical intervention is recommended to prevent progression to higher-risk NYHA Class IV status.
- Survivors demonstrate significant functional class improvement, supporting the benefits of surgery in carefully selected elderly patients.
Abstract:
Seventy-six consecutive patients, aged 80 to 89 (mean 82), underwent cardiac operations with cardiopulmonary bypass. Hypothermia (22 degrees C) and hyperkalemic cardioplegia were used in each. There were 35 men and 41 women. Thirteen patients (17%) were in New York Heart Association Functional Class III and 62 patients (81%) were in Class IV preoperatively. Coronary bypass procedures (Group I) were performed in 38 patients, of whom five had combined carotid endarterectomy. The average number of grafts was 3.7 per patient. There were two early deaths (5.2%). Single or double valve replacement, without coronary bypass (Group II), was done in 15 patients, with one early death (6.6%). Coronary bypass and valve procedures (Group III) were performed in 23 patients with seven early deaths (30%). Total early mortality was 10 deaths in 76 patients (13%). Of the 66 (87%) 30 day survivors, 19 (29.1%) had major postoperative complications, including bleeding, pericardial tamponade, sternal dehiscence, myocardial infarction, arrhythmia, and pump failure. Mean hospital stay was 23 days (9 to 117 days). Late cardiac-related deaths occurred in eight patients (9%) during the 58 (mean 28) months of follow-up. Thus combined early and late mortality was 18 deaths (24%). Mortality at any time was related to Functional Class IV status (17/18 deaths, 94% in Class IV); combined procedures (12/28 patients died, 43%); use of intra-aortic balloon pumping (8/13 patients died, 62%); and postoperative bleeding necessitating reoperation (4/6 patients died, 67%). At follow-up 84% of survivors had improved by one or more functional classes, and there was a low incidence of cardiac-related late deaths. This experience supports the concept that in octogenarians the indications for operation should be as for other patients of less advanced age, especially in those with isolated coronary artery disease and pure valve disease. Operation should not be delayed, so that these patients will not advance to higher-risk Class IV status preoperatively.