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Single-institution effectiveness assessment of open-heart surgery in octogenarians
B A de Mol1, M Kallewaard, F Lewin
1Department of Cardiopulmonary Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
Insights
Open-heart surgery in octogenarians shows acceptable operative mortality and good long-term quality of life. Key risk factors for mortality include bypass time and left main stem disease.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Outcomes Research
Background:
- Octogenarians represent a growing population undergoing cardiac procedures.
- Assessing surgical outcomes in this age group is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of open-heart surgery in patients aged 80 years and older.
- To identify risk factors influencing mortality and morbidity in this cohort.
Main Methods:
- Retrospective review of 130 octogenarian patients undergoing open-heart surgery.
- Exclusion of patients with significant comorbidities.
- Analysis of operative and cardiac risk factors for mortality and morbidity.
- Post-study follow-up via general practitioners and cardiologists for functional status.
Main Results:
- Operative mortality for valve replacement and coronary artery bypass grafting was 11.5%.
- Four-year survival was 73.5%, with 75.9% living independently.
- Increased operative mortality risk associated with prolonged cardiopulmonary bypass time (>95 min) and left main stem disease.
- Reduced left ventricular ejection fraction (<50%) increased late death risk.
Conclusions:
- Open-heart surgery in octogenarians presents an acceptable mortality risk.
- The procedure demonstrates effectiveness in improving quality of life for this demographic.
- Findings from smaller patient groups can provide valuable insights comparable to large multicenter studies.
Objective:
To determine short- and long-term outcome of open-heart surgery in octogenarians.
Methods:
We reviewed the medical charts of 130 consecutive octogenarians undergoing open-heart surgery. Patients with significant comorbidity were excluded from the study. The effect of cardiac and operative risk factors on mortality and morbidity was evaluated. General practitioners and cardiologists were contacted in order to obtain information on the patients' current medical and functional status.
Results:
Operative mortality for valve replacement (VR) and coronary artery bypass grafting (CABG) was 11.5%. Four-year survival was 73.5% with 75.9% still living independently. The relative risk for operative mortality was 4.3 in case of extracorporeal bypass time exceeding 95 min and 3.6 in case of significant left main stem disease. The risk of late death increased 2.5 times at a left ventricular ejection fraction lower than 50%.
Conclusions:
Our data match the results of similar studies involving large numbers of patients. When a multicenter data bank is missing, the evaluation of a relatively small patient group can yield information that may be as useful to patient and physician as information obtained by large studies. Open-heart surgery in octogenarians carries an acceptable mortality risk and its effectiveness in terms of improved quality of life is good.