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Surgery using cardiopulmonary bypass in the elderly.

L W Stephenson, H MacVaugh, L H Edmunds

    Circulation
    |August 1, 1978
    PubMed
    Summary
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    This study found that coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) are safe for elderly patients, with good outcomes. However, mitral valve replacement (MVR) carries a significantly higher risk in this population.

    Area of Science:

    • Cardiovascular Surgery
    • Geriatric Medicine
    • Outcomes Research

    Background:

    • Elderly patients often present with severe heart conditions requiring surgical intervention.
    • Previous data on the safety and efficacy of cardiac procedures in the elderly population is limited.
    • High-risk patient profiles necessitate careful evaluation of surgical outcomes.

    Purpose of the Study:

    • To evaluate the safety and outcomes of various cardiac surgical procedures in elderly patients (≥70 years).
    • To compare the mortality and morbidity associated with aortic valve replacement (AVR), coronary artery bypass grafting (CABG), and mitral valve replacement (MVR) in this age group.
    • To assess the long-term survival and symptomatic improvement following these procedures.

    Main Methods:

    • Retrospective analysis of 89 patients aged 70-82 years who underwent cardiac procedures between 1955 and the study period.

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  • Procedures included elective and emergency AVR, CABG, combined AVR and CABG, MVR, thoracic aortic aneurysm repair, and other cardiac surgeries.
  • Data collected included hospital mortality, late deaths, New York Heart Association (NYHA) functional class, and long-term survival rates.

    • Main Results:

    • Overall hospital mortality was 18% (16 of 89 patients).
    • CABG had no early deaths; elective AVR had a 7.7% mortality. Combined AVR/CABG had 10% mortality.
    • Mitral valve replacement (MVR) demonstrated a significantly high hospital mortality of 57%.
    • 84% of hospital survivors showed symptomatic improvement of at least one NYHA Functional Class.

    Conclusions:

    • Coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) can be performed with acceptable hospital mortality in elderly patients, leading to symptomatic improvement.
    • Mitral valve replacement (MVR) in elderly patients is associated with an exceptionally high mortality rate, approximately 7.3 times greater than in younger patients.
    • The high risk of MVR in the elderly necessitates careful consideration and risk-benefit analysis before proceeding with the surgery.