Outcomes of cardiac surgery in nonagenarians: a 10-year experience.
BACKGROUND
With an increasing awareness of health issues and greater emphasis on preventive medicine, the general population is living longer and healthier lives than ever before. Physicians are taking care of older patients, many of whom may require cardiac surgical procedures. Improving cardiopulmonary bypass technology allows for safer procedures with reduced morbidity and mortality even in older patients.


METHODS
We have performed a retrospective analysis of 42 consecutive nonagenarian patients who underwent open-heart procedures over a 10-year period (1993 to 2002) at our institution. Their demographic profiles, operative data, perioperative results, and long-term outcomes were recorded and analyzed.


RESULTS
Twenty-two women and 20 men with an age range of 90 to 97 years (mean, 91.4 years) had open-heart surgery over the study period. The complication rate was 67% overall, consisting of 7% respiratory (pneumonia, respiratory failure, reintubation), 7% hemorrhagic or embolic (postoperative bleeding, cerebral vascular accident), 12% infectious (wound infection, sepsis), and 31% new arrhythmia (atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation). Despite these complication rates, average hospital stay was 17.5 days (median, 11 days), with an intensive care unit stay of 12.0 days (median, 5 days). Thirty-day survival was 95% and survival to discharge was 93% (three deaths total; one cardiac arrest at hospital day 134 and two perioperative deaths; one ventricular arrhythmia, one cerebral vascular accident). The only statistically significant risk factor of mortality was emergency surgery. Currently, 81% are still alive an average of 2.53 years since surgery (range, 0.16 to 7.1 years).


CONCLUSIONS
With improving techniques and greater attention to detail, the select nonagenarian can safely undergo cardiac surgery.
Bacchetta
Matthew D
MD
Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Cornell University Medical College, New York, New York 10021, USA.
Ko
Wilson
W
Girardi
Leonard N
LN
Mack
Charles A
CA
Krieger
Karl H
KH
Isom
O Wayne
OW
Lee
Leonard Y
LY
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004630:Emergencies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome