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Favorable results of coronary artery bypass and/or valve replacement in octogenarians
J J Yashar1, A G Yashar, D Torres
1Division of Cardiac Surgery, Miriam Hospital, Providence, Rhode Island.
Insights
Octogenarian patients undergoing open heart surgery had a higher mortality rate (9%) compared to younger patients. However, survivors showed good long-term outcomes, with 86% survival at 14 months post-surgery.
Area of Science:
- Cardiology
- Geriatric Surgery
Background:
- Open heart surgery in octogenarians (patients aged 80 and older) presents unique challenges.
- A significant proportion of these elderly patients present with severe angina and a history of myocardial infarction.
- Urgent procedures are common in this demographic.
Purpose of the Study:
- To evaluate the outcomes of open heart surgery in octogenarian patients.
- To compare the mortality and morbidity of octogenarians with younger surgical patients.
- To assess the long-term survival and functional status of octogenarian survivors.
Main Methods:
- Retrospective analysis of 43 octogenarian patients undergoing open heart surgery between October 1987 and July 1990.
- Comparison of mortality rates with a cohort of patients younger than 80 years.
- Follow-up assessment of operative survivors for functional status (angina score) and survival probability.
Main Results:
- The hospital mortality rate for octogenarians was 9%, significantly higher than the 3.6% rate in patients younger than 80.
- Coronary bypass surgery (60%) and valve replacement (26%) were the most common procedures.
- Operative survivors demonstrated good long-term outcomes, with an 86% actuarial survival rate at a mean follow-up of 14 months and improved angina scores.
Conclusions:
- Octogenarians undergoing open heart surgery face increased perioperative mortality risk.
- Despite higher initial risks, octogenarian survivors of open heart surgery can achieve favorable long-term survival and functional improvement.
- Careful patient selection and risk stratification are crucial for this elderly population.
Abstract:
Between October 1987 and July 1990, of 763 patients undergoing open heart surgery, 43 (5.6%) were 80 (mean and median 82) years of age or older. There were 20 men and 23 women. Eighteen patients (42%) were initially assessed using the angina score of the New York Heart Association or Canadian Cardiovascular Association as class IV. Nine procedures (21%) were performed electively and 34 (79%) urgently. A total of 26 patients (60%) underwent coronary bypass surgery, while 11 (26%) had valve replacements and six (14%) had both coronary bypass surgery and valve replacement; 74% of the patients received two or more grafts. The hospital mortality rate of the octogenarian patients was 9% (four of 43), significantly higher (P < 0.05) than the overall hospital mortality rate of 3.6% for patients < or = 79 years of age. A history of myocardial infarction within 2 weeks before the procedure was obtained in nine of 43 patients (21%); 22 (51%) had experienced at least one myocardial infarction before surgery. Ejection fractions were 'normal' in 28 patients (65%), 'fair' in nine (21%) and 'poor' in six (14%). The mean length of hospital stay for the octogenarian patients was 19 (range 8-64) days. Thirty-five of the 39 operative survivors were followed for a mean of 14 (range 3-35) months. The actuarial probability of survival was 86% at the end of this time. A total of 31 patients (79%) assessed using the angina score of the New York Heart Association or Canadian Cardiovascular Association were class I or II. During the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)