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Heart surgery in patients aged eighty years and above: determinants of morbidity and mortality
M Deiwick1, R Tandler, T Möllhoff
1Department of Cardiothoracic and Vascular Surgery, Westfälische Wilhelms University, Münster, Germany.
Insights
Heart surgery in octogenarians shows acceptable operative risk and good long-term outcomes. Preoperative intensive care unit stay is a key predictor of mortality, while patient risk profiles guide survival and morbidity expectations.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Rising healthcare costs necessitate cost-effective medical care and risk stratification.
- Evaluating outcomes of heart surgery in octogenarians is crucial for resource allocation.
- Previous studies on elderly cardiac surgery outcomes are limited.
Purpose of the Study:
- To evaluate the results of open heart surgery in patients aged 80 years and above.
- To identify preoperative and operative risk factors influencing morbidity and mortality.
- To assess long-term quality of life and survival rates in this patient cohort.
Main Methods:
- Prospective, single-center study including 101 consecutive octogenarian patients undergoing open heart surgery.
- Data collection on patient demographics, preoperative functional status (NYHA classes), surgical procedures (CABG, AVR, valve repair), and postoperative outcomes.
- Uni- and multivariate statistical analyses to determine risk factors for mortality and complications.
- Long-term follow-up focusing on morbidity, quality of life, and survival.
Main Results:
- 30-day overall mortality was 7.9%.
- Independent predictor of operative mortality was preoperative intensive care unit (ICU) stay.
- Significant risk factors for postoperative complications included prior stroke, diabetes mellitus, NYHA class IV symptoms, and prolonged cross-clamping time.
- Cumulative survival rates were 87.9% at 1 year, 79.5% at 2 years, and 72.9% at 5 years.
- 82.8% of discharged patients were in NYHA functional class I or II.
Conclusions:
- Cardiac surgery in octogenarians can be performed with acceptable operative risk.
- Favorable long-term outcomes and quality of life are achievable in this elderly population.
- Individual patient risk profiles, including comorbidities and disease severity, are critical for predicting survival and perioperative morbidity.
Abstract:
Escalating medical costs, limitation of resources and the necessity to provide cost-effective medical care have created a need for systematic risk stratification and cost-benefit analyses in the background of an ongoing discussion. Results of heart surgery in octogenarians have been evaluated in a prospective single-center, study since 1990. 101 consecutive patients (55/ 101 = 54.5% female) aged 80 years and above (median: 81 years; interquartile range [IQR]: 80.0-82.5, total range [TR]: 80-92 years) undergoing open heart surgery at our institution between January 1990 and March 1996 were included into this prospective study. Prior to surgery, most patients were severely symptomatic being in functional NYHA classes either III (56.4%) or IV (31.7%). 61/101 (60.4%) patients underwent isolated coronary artery bypass grafting (CABG), 23 (22.8%) had aortic valve replacement (AVR), 14 patients (13.9%) had CABG combined with AVR or double valve replacement and 3 (3.0%) had mitral valve repair. Follow-up (median: 23.0 months. IQR: 10.5-39.0, TR: 1-72) was focused on long-term morbidity and quality of life. The impact of preoperative and operative risk factors on morbidity and mortality was determined by uni- and multivariate statistical analysis. The 30-days overall mortality in this study was 7.9%. The postoperative course was uneventful for 27 (26.7%) of our patients. Univariate risk factors of postoperative mortality were: left main stem disease (p < or = 0.044), ejection fraction < 45% (p < or = 0.006), preoperative intensive care unit (ICU) (p < or = 0.002), urgent or emergency operation (p < or = 0.034). The only independent predictor of operative mortality was preoperative ICU-stay (p < or = 0.008). Significant risk factors for the number of postoperative complications in the multivariate analysis were: prior stroke (p < or = 0.04), diabetes mellitus (p < or = 0.02), New York Heart Association (NYHA) class IV symptoms (p < or = 0.002) and prolonged cross-clamping time (p < or = 0.001). Mean postoperative length of stay in the ICU was 3.9 +/- 3.9 days. Late morbidity was not related to postoperative complications. Cumulative survival was 87.9%, 79.5% and 72.9% at one, two or five years, respectively. After hospital discharge, 67/93 patients (82.8%) were in NYHA functional class I or II. Cardiac surgery in very elderly patients can be performed with acceptable operative risk and a favorable long-term outcome. The individual patient risk-profile including significant co-morbid conditions and severity of the heart disease predicts not only survival but the extent of perioperative morbidity.