Early and long-term results of cardiovascular surgery in octogenarians.
The purpose of this study was to evaluate characteristics and outcomes of octogenarians undergoing cardiovascular surgery with cardiopulmonary bypass in a Japanese population. Thirty-one consecutive patients over 80 years of age underwent coronary artery bypass grafting 19 (61%), combined coronary artery bypass grafting and ventricular septal perforation closure 1 (3%), valve replacement 3 (10%), and prosthetic graft replacement 8 (26%). The early mortality rate was 16.1%. Survival estimates were 74% after 1 year, 74% after 3 year, and 64% after 5 years. Emergency and urgent cases involved 16 (51.6%), and 2 patients (6.5%), respectively. Multivariate analyses revealed that predictors of early mortality was preoperative left ventricular ejection fraction. Predictors of hospital death (within 3 months after surgery) were preoperative renal dysfunction, intraaortic balloon pumping, and age. Predictors of late mortality were chronic lung disease and age. Twenty-one patients expected to have died before surgery were living at home, and 9 (40.9%) patients were completely autonomous. Multivariate analyses revealed diabetes mellitus and a small number of bypass grafts were predictive risk factors for postoperative autonomy. Thus, cardiovascular surgery can be performed in octogenarians under 85 years of age with a favorable long-term outcome, when appropriately applied in selective octogenarians without significant comorbidity. If patients are over 85 years of age or have significant comorbidity, clinical treatment recommendations should be individually tailored while evaluating the risk of having or not having surgery and their life expectancy. QOL of survivors was almost satisfactory and significantly improved compared with a preoperative state.
Shigemitsu
O
O
Emergency Center and Cardiovascular Surgery, Oita Medical University, Hasama-machi, Oita 879-5593, Japan.
Hadama
T
T
Miyamoto
S
S
Anai
H
H
Sako
H
H
Wada
T
T
Iwata
E
E
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000401:mortality; D013504:Cardiovascular Surgical Procedures / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005610:Freedom; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D007362:Intensive Care Units; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome