Cardiac operations in patients 80 years old and older.
BACKGROUND
Because the elderly are increasingly referred for operation, we reviewed results with cardiac surgical patients 80 years old or older.


METHODS
Records of 600 consecutive patients 80 years old or older having cardiac operations between 1985 and 1995 were reviewed. Follow-up was 99% complete.


RESULTS
Two hundred ninety-two patients had coronary grafting (CABG), 105 aortic valve replacement (AVR), 111 AVR + CABG, 42 mitral valve repair/ replacement (MVR) +/- CABG, and 50 other operations. Rates of hospital death, stroke, and prolonged stay (> 14 days) were as follows: CABG: 17 (5.8%), 23 (7.9%) and 91 (31.2%); AVR: 8 (7.6%), 1 (1.0%), and 31 (29.5%); AVR + CABG: 7 (6.3%), 12 (10.8%), and 57 (51.4%); MVR +/- CABG: 4 (9.5%), 3 (7.1%), and 16 (38.1%); other: 9 (18.0%), 3 (6.0%), and 23 (46.0%). Multivariate predictors (p < 0.05) of hospital death were chronic lung disease, postoperative stroke, preoperative intraaortic balloon, and congestive heart failure; predictors of stroke were CABG and carotid disease; and predictors of prolonged stay were postoperative stroke and New York Heart Association class. Actuarial 5-year survival was as follows: CABG, 66%; AVR, 67%; AVR + CABG, 59%; MVR +/- CABG, 57%; other, 48%; and total, 63%. Multivariate predictors of late death were renal insufficiency, postoperative stroke, chronic lung disease, and congestive heart failure. Eighty-seven percent of patients believed having a heart operation after age 80 years was a good choice.


CONCLUSIONS
Cardiac operations are successful in most octogenarians with increased hospital mortality, postoperative stroke, and longer hospital stay. Long-term survival is largely determined by concurrent medical diseases.
Akins
C W
CW
Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
Daggett
W M
WM
Vlahakes
G J
GJ
Hilgenberg
A D
AD
Torchiana
D F
DF
Madsen
J C
JC
Buckley
M J
MJ
D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over / Q000706:statistics & numerical data; D001021:Aortic Valve / Q000601:surgery; D001294:Attitude to Health; D001900:Boston / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002340:Carotid Artery Diseases / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012017:Referral and Consultation; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis