Cardiac Surgery In Octogenarians

A number of studies have focused on cardiac surgery outcomes in octogenarians4-6. The range of operative mortality is 10% or higher in many series. These studies have often demonstrated a higher proportion of females in their study groups, likely as a result of higher life expectancies seen in women. Three recent studies warrant further mention.

Rady et al. retrospectively evaluated 783 patients undergoing any type of cardiac surgical procedure4. This cohort included 96 patients who were octogenarians. This group had a higher prevalence of pulmonary hypertension, cerebrovascular disease, congestive heart failure, and valvular disease. Operative procedures were more complicated, with multiple procedures more common in this group. The results were notable for age identified as an independent predictor—either death or discharge to a nursing facility (53% in octogenarians vs. 14% in younger patients). Coincident with this was a significant increase in the hospital charges, which led the authors to question the cost-effectiveness of offering operative therapy for octogenarians.

Collart et al. reviewed a group of 213 patients undergoing valvular surgery, with special emphasis on both operative and long-term mortality5. The mean age of their study population was 83 years, and the majority (74%) underwent aortic valve replacement. Operative mortality was 8.8%, and the only multivariate preoperative predictor of death was a reduced ejection fraction.

Emergent status, accounting for 11.2% of patients, did not fall out as an important predictor of mortality. The five-year survival in the entire group was 56%, similar to the general population at the same age.

Finally, a study by Bridges et al. utilized the Society of Thoracic Surgeons National Database to review the results of cardiac surgery in almost 60,000 patients aged 80 years and older from 1997 to 20006. In this report, 30-day mortality varied from 7% to 12%, depending on the operative procedure. This was in contrast to the 2-7% mortality for patients younger than 80 years. They concluded that coronary bypass grafting could be performed in older patients with careful patient selection.

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