Surgical results in cardiac patients over the age of 80 years

Improved medical care over the years has increased life expectancy and consequently the number of aged persons suffering from cardiac disease. During the past 3 years, 42 consecutive octogenarians, with an average age of 82.1 years, were evaluated. Thirty patients had coronary artery bypass graft surgery (CABG), 5 had aortic valve replacement (AVR), and 7 had combined CABG-AVR surgery. Among the ischemic patients 70% had suffered from unstable angina pectoris, and an average of 2.78 +/- 1 grafts per patients were performed. The left internal mammary artery was used in 12 patients (32%). Overall mortality was 7.1% (3 patients), while operative mortality was 2.4% (1 patient). Another two patients who expired during the 34 month follow-up period underwent AVR. The average hospitalization period was 10.2, 12 and 17.6 days for patients undergoing CABG, combined CABG-AVR, and AVR alone, respectively. Complications occurred in 10 patients (24%) and included neurologic deficits (in 2 patients), severe wound infection (in 2), cardiac arrhythmia (in 4), renal failure (in 1) and adult respiratory distress syndrome (in 1). The use of the left internal mammary artery was not associated with an increased incidence of complications. The low rate of mortality and major complications and the substantial improvement in quality of life led us to conclude that, when indicated, surgical treatment should be offered to selected elderly individuals who otherwise are in good physical and mental health.