Cardiac surgery in nonagenarians.
OBJECTIVE
The purpose of this study was to document our initial experience with patients 90 years of age and older and to determine whether cardiac surgery is justified in this age group. Cardiac surgery in octogenarians has proven to be a successful and worthwhile procedure. A small group of nonagenarians with severe coronary artery disease (CAD) and aortic valve disease refractory to medical therapy have been considered for surgery.


METHODS
Fourteen patients aged 90 or more underwent cardiac surgery for symptomatic CAD or aortic valvular disease refractory to medical therapy. Eight patients underwent isolated coronary artery bypass grafting (CABG) and six patients underwent aortic valve replacement (AVR). All patients were in NYHA Class IV preoperatively.


RESULTS
Hospital mortality occurred in one patient (7%). Hospital morbidity occurred in 10 patients (71%) and included 7 cardiac, 5 neurological, 1 gastrointestinal, 1 infectious, and 1 pulmonary event. All survivors left the hospital symptomatically improved. The mean length of stay was 26 days. Four CABG patients went on to die at a mean of 2 years and 2 months, and 3 remain alive at a mean of 2 years and 4 months. Three AVR patients expired at a mean of 3 years and 4 months, and 3 remain alive at 4 years and 1 month.


CONCLUSIONS
Cardiac surgery in carefully selected nonagenarians is justified and can be performed with acceptable results.
Samuels
L E
LE
Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, PA 19102-1192, USA.
Sharma
S
S
Morris
R J
RJ
Kuretu
M L
ML
Grunewald
K E
KE
Strong
M D
MD
Brockman
S K
SK
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001024:Aortic Valve Stenosis / Q000601:surgery; D001145:Arrhythmias, Cardiac / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery; D009460:Neurologic Examination; D011183:Postoperative Complications; D015996:Survival Rate