Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy.
BACKGROUND
With the progressive aging of western populations, cardiac surgeons are increasingly faced with elderly patients.


METHODS
We reviewed the records of 191 consecutive patients aged 80 years or older (mean age, 83 +/- 2.4 years) who underwent a cardiac surgical procedure at our institution from 1991 through 1996.


RESULTS
Ninety-eight patients were men. Preoperatively, 32% of patients were in New York Heart Association class III or IV, and mean left ventricular ejection fraction was 0.55 +/- 0.02. One hundred ten patients (58%) underwent aortic valve replacement, 47 (25%) had coronary artery bypass grafting, 26 (14%) had combined aortic valve replacement and coronary artery bypass grafting, 5 (3%) underwent mitral valve replacement, and 3 (1.6%) had other procedures. Postoperative complications occurred in 69.1% of patients. The hospital mortality rate was 16.2%. Actuarial survival estimates at 1 year, 3 years, and 5 years were 79.2%, 74.9%, and 56.2%, respectively. Multivariate predictors (p < 0.05) of hospital death were preoperative pulmonary hypertension and lower left ventricular ejection fraction. Multivariate predictors of late death were combined aortic valve replacement and coronary artery bypass grafting and female sex. Sixty-four percent of long-term survivors were fully autonomous, and female sex was the only independent predictor of impaired autonomy. Eighty-three percent of survivors were satisfied with their present quality of life.


CONCLUSIONS
Cardiac operations can be performed in octogenarians with a favorable long-term outcome. Earlier referral and intervention is mandatory to improve results in this patient population.
Department of Thoracic and Cardiovascular Surgery, Hôpital Henri Mondor, Créteil, France.
M
M
Kirsch
L
L
Guesnier
P
P
LeBesnerais
M L
ML
Hillion
M
M
Debauchez
J
J
Seguin
D Y
DY
Loisance
D000203:Activities of Daily Living; D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over / Q000502:physiology / Q000523:psychology / Q000706:statistics & numerical data*; D001021:Aortic Valve / Q000601:surgery; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology; D016277:Ventricular Function, Left