Good outcomes from cardiac surgery in the over 70s.
OBJECTIVE
To determine the early mortality and major morbidity associated with cardiac surgery in the elderly.


METHODS
Retrospective case record review study of 575 patients >/= 70 years old who underwent cardiac surgery at the Manchester Heart Centre between January 1990 and December 1996.


METHODS
Regional cardiothoracic centre.


METHODS
Patients >/= 70 years old who underwent cardiac surgery.


METHODS
Comparison of 30 day mortality and incidence of major morbidity between patients >/= 70 years old and patients < 70 years old.


RESULTS
Of 4395 cardiac surgical operations, 575 operations (13.1%) were in patients aged >/= 70 years (mean (SD) 73.1 (3.2) years). The proportion of elderly patients rose progressively from 7.9% in 1990 to 16.5% in 1996. 334 patients (58.1%) had coronary artery bypass grafting alone, 91 patients (15.8%) had valve surgery alone, and 129 patients (22.4%) had combined valve surgery and bypass grafting. For isolated coronary artery bypass grafting, 30 day mortality in patients >/= 70 years was 3.9% compared with 1.3% in patients < 70 years (p < 0.001). 30 day mortality for isolated valve surgery in patients >/= 70 years was 7.7%. Isolated aortic valve replacement was the most common valvar procedure in patients >/= 70 years and carried the lowest mortality (4.3%). Additional coronary artery bypass grafting increased the mortality rate in patients >/= 70 years to 9.3% for all valve surgery and to 8.0% for aortic valve replacement. Major morbidity in patients >/= 70 years was low for all procedure types (stroke 1.9%, acute renal failure requiring dialysis 1.6%, perioperative myocardial infarction 0.5%).


CONCLUSIONS
Early mortality and major morbidity is low for cardiac surgery in elderly patients. Concerns over the risk of cardiac surgery in the elderly should not prevent referral, and elderly patients usually do well. However, unconscious rationing of health care may affect referral patterns, and studies that assess the cost effectiveness of cardiac surgery versus conservative management in such patients are lacking.
Manchester Heart Centre, The Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. amir@mhc.cmht.nwest.nhs.uk
A M
AM
Zaidi
A P
AP
Fitzpatrick
D J
DJ
Keenan
N J
NJ
Odom
G J
GJ
Grotte
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies