title: Cardiac surgery in nonagenarians.
abstract: OBJECTIVE
  To evaluate outcomes following cardiac surgery in nonagenarians.
  
  
  METHODS
  A retrospective analysis of patients > or = 90 years of age undergoing cardiac surgery at Barnes-Jewish Hospital from 1996-2006 was performed. The Social Security Death Index was used to determine late survival.
  
  
  RESULTS
  Twenty-two subjects were identified. The mean age was 91 years (range 90-94) and 64% were women. The most common comorbidities included hypertension in 91% and heart failure (HF) in 65%. Mean New York Heart Association class was 3.5, mean left ventricular ejection fraction was 50% (range 27-80%), and mean creatinine clearance was 34 +/- 11 cc/min. No patients had prior cardiac surgery. Nine patients underwent coronary bypass grafting only, 11 had valve replacement only, and 2 had both. Concurrent operations included 1 ventricular septal defect repair, 2 carotid endarterectomies, and 1 ascending aortic patch angioplasty. Two cases were urgent, 2 were emergent, and the remainder were elective. There was one intraoperative death (5%), during urgent mitral valve replacement. The most common postoperative complications included atrial fibrillation and need for vasopressors for >48 hrs. Mean length of intensive care and total hospital stay were 3.4 +/- 4.5 and 12.2 +/- 8.5 days, respectively. Independent predictors of increased hospital stay were higher serum creatinine (P=0.028) and the presence of HF (P=0.050). Survival to 30, 90 and 365 days were, respectively: 86%, 77%, and 64%. At study conclusion, 7 patients (32%) were alive at a mean follow-up of 4.1 years.
  
  
  CONCLUSIONS
  Despite higher morbidity and mortality, in carefully selected nonagenarians referred for cardiac surgery, short-term complication rates and long-term outcomes appear to be acceptable.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hovanesyan
authors.forename: M R
authors.initials: MR
authors.lastname: Moon
authors.forename: M W
authors.initials: MW
authors.lastname: Rich
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome