Early and late outcomes of cardiac surgery in octogenarians.
BACKGROUND
Expanding demand for cardiac surgery in the elderly requires constant assessment of selection criteria and outcomes.


METHODS
Records of consecutive patients 80 years old or greater (n = 355) having cardiac operations from September 1998 through May 2007 were reviewed. There were 172 isolated coronary bypass grafting (CABG), 73 isolated valve, 79 valve and CABG combined, and 31 other procedures.


RESULTS
Thirty-three (9.3%) deaths and 13 (3.7%) strokes occurred during the index hospital stay. Intensive care unit and hospital length of stay lasted 6.3 +/- 14.3 and 15.5 +/- 20.8 days, respectively. Overall cumulative 5-year survival was 65.5 +/- 3.3%, varying among procedures as follows: 67.9 +/- 4.4% for isolated CABG, 64.6 +/- 8.9% for valve surgery, 60.3 +/- 7.3% for combined coronary and valve surgery, and 63 +/- 10.7% for other procedures (p = 0.23). Ninety-seven percent of survivors lived at home. Risk factors for hospital death were emergency status, preoperative renal dysfunction, and postoperative complications such as myocardial infarction, cardiac failure requiring intraaortic balloon pumping, acute renal failure requiring replacement therapy, stroke, and ventilator dependency exceeding 48 hours. Among hospital survivors, risk factors for late death were carotid artery disease, chronic lung disease, renal dysfunction, and the occurrence of postoperative complications.


CONCLUSIONS
Long-term survival of octogenarians submitted to a wide variety of cardiac operations was satisfactory despite substantial rates of early complications and deaths. Most survivors were free from cardiac symptoms. Postoperative complications were stronger risk factors for hospital deaths than preoperative comorbidities and procedural variables. Their impact on long-term survival was also significant.
Zingone
Bartolo
B
Division of Cardiac Surgery, Ospedali Riuniti di Trieste, Trieste, Italy. bartolo.zingone@aots.sanita.fvg.it
Gatti
Giuseppe
G
Rauber
Elisabetta
E
Tiziani
Paola
P
Dreas
Lorella
L
Pappalardo
Aniello
A
Benussi
Bernardo
B
Spina
Amedeo
A
D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D005260:Female; D015577:Geriatric Assessment; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome