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Open-heart surgery in a growing geriatric population: patient selection and risk factors to be considered
1Department of Cardiothoracic Surgery, University Hospital, Lund, Sweden.
Insights
This study analyzed cardiac surgery outcomes in 598 elderly patients (≥75 years). Predictors of poor outcomes were identified, with specific mortality rates for different procedures in this vulnerable population.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Clinical Outcomes Research
Background:
- Cardiac surgery in elderly patients (≥75 years) presents unique challenges.
- Understanding outcomes and predictors is crucial for optimizing care in this demographic.
Purpose of the Study:
- To describe the experience with cardiac surgery in elderly patients.
- To identify predictors of poor outcomes following these procedures.
Main Methods:
- A consecutive series of 598 patients aged 75 years and older underwent cardiac surgery.
- Procedures included valve replacement, coronary artery bypass grafting (CABG), and combined or complex surgeries.
- Data collected from 1980-1993, with long-term follow-up.
Main Results:
- In-hospital mortality ranged from 0.8% (valve replacement) to 12.6% (other complex procedures), with an overall rate of 5.5%.
- Long-term mortality was 12.0% among hospital survivors after an average follow-up of 23 months.
- Severe concomitant diseases were present in 34.9% of patients.
Conclusions:
- Cardiac surgery in patients aged 75 and older can be performed with acceptable mortality rates.
- Identifying predictors of poor outcomes is essential for risk stratification and patient selection.
- Further research into optimizing surgical strategies for elderly cardiac patients is warranted.
Aims:
This report describes our experience with cardiac surgery in elderly patients and aims to ascertain predictors of poor outcome.
Patients:
Five hundred and ninety-eight (598) consecutive patients aged 75 years and older underwent cardiac surgery at the Department of Cardiothoracic Surgery, University Hospital of Lund, Sweden, between January 1980 and December 1993. There were 324 men (54%) and 274 women (46%); their age varied between 75 and 91 years (mean age +/- SD, 77.8 +/- 2.6 years). One hundred and twenty-nine patients underwent aortic, mitral or combined valve replacement, 273 patients underwent exclusive coronary revascularization (CABG) alone and 109 underwent a surgical procedure which included valve replacement and concomitant CABG. The remainder (87 patients) underwent other, more complex surgical procedures.
Results:
The 30-day or in-hospital mortality rate was 5.5% (0.8% for valve replacement, 5.1% for CABG, 5.5% for valve replacement with concomitant CABG, and 12.6% for other procedures). Concomitant severe diseases occurred in 34.9% of the patients. All surviving patients were evaluated during June 1994. None of the patients was lost to follow-up. The 566 long-term survivors have been followed for an average of 23.0 months (median 21; range 1-53 months). Late mortality was 12.0% in the 566 hospital survivors. Only 17 patients experienced late complications (after hospital discharge), as an adverse effect linked to heart surgery.