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Cardiac Surgery in Nonagenarians Following the TAVI/TMVI Era: A Multicenter 23-Year Comparative Analysis
Giuseppe Nasso1, Giuseppe Santarpino2,3,4, Nicola Di Bari5
1Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70100 Bari, Italy.
Journal of Clinical Medicine
|March 29, 2023
Summary
Outcomes for nonagenarian cardiac surgery patients significantly improved from 1998-2008 to 2009-2021. Recent open-heart surgery in patients over 89 years old shows reduced mortality and better survival rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Limited data exists on cardiac surgery outcomes for patients aged 90 years and older.
- Trans-catheter procedure data for this age group is even scarcer.
- This study addresses the need for more information on surgical outcomes in nonagenarians.
Purpose of the Study:
- To compare the outcomes of open cardiac surgery in nonagenarian patients between two distinct time periods.
- To evaluate changes in surgical approaches and patient survival over time.
- To identify factors contributing to improved outcomes in this elderly population.
Main Methods:
- A comparative analysis of patients aged over 89 undergoing open cardiac surgery.
- Data collected from 8 Italian cardiac surgery centers, comparing two cohorts: 1998-2008 (n=127) and 2009-2021 (n=101).
- Exclusion of percutaneous valve repair/implantation procedures; focus on traditional "open" surgery.
Main Results:
- Both groups had comparable preoperative risk factors (LogEuroSCORE).
- Significant differences observed in surgical procedure types between the two periods (p=0.01).
- The more recent cohort (2009-2021) demonstrated significantly improved 30-day survival rates (5.9% vs. 13.4%, p=0.001), particularly in isolated coronary and valve surgeries.
Conclusions:
- Enhanced pre-, intra-, and post-operative management strategies have led to significant improvements in nonagenarian cardiac surgery outcomes.
- The findings highlight the benefits of refined clinical practices in improving survival for very elderly patients.
- These results suggest that optimized care can mitigate biological impacts and enhance surgical success in nonagenarians.
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