title: Operative and middle-term results of cardiac surgery in nonagenarians: a bridge toward routine practice.
abstract: BACKGROUND
  Age >90 years represents in many centers an absolute contraindication to cardiac surgery. Nonagenarians are a rapidly growing subset of the population posing an expanding clinical problem. To provide helpful information in regard to this complex decision, we analyzed the operative and 5-year results of coronary and valvular surgical procedures in these patients.
  
  
  RESULTS
  We retrospectively reviewed 127 patients aged >or=90 years who underwent cardiac surgery within our hospital group in the period 1998 to 2008. Kaplan-Meier and multiple logistic regression analyses were performed. A longer follow-up than most published studies and the largest series published thus far are presented. Mean age was 92 years (range, 90 to 103 years). Mean logistic EuroSCORE was 21.3+/-6.1. Sixty patients had valvular surgery (including 11 valve repairs), 49 patients had coronary artery bypass grafting, and 18 had valvular plus coronary artery bypass grafting surgery (55 left mammary artery grafts implanted). Forty-five patients (35.4%) were operated on nonelectively. Operative mortality was 13.4% (17 cases). Fifty-four patients (42.5%) had a complicated postoperative course. There were no statistically significant differences in the rate and type of complications between patient strata on the basis of type of surgery performed. Nonelective priority predicted a complicated postoperative course. Predictors of operative mortality were nonelective priority and previous myocardial infarction. Kaplan-Meier survival estimates at 5 years were comparable between patient groups on the basis of procedure performed.
  
  
  CONCLUSIONS
  Although the rate of postoperative complications remains high, cardiac surgery in nonagenarians can achieve functional improvement at the price of considerable operative and follow-up mortality rates. Cardiac operations in these very elderly subjects are supported if appropriate selection is made and if the operation is performed earlier and electively. Our results should contribute to the development of guidelines for cardiac operations in nonagenarians.
authors.affiliation: Gruppo Villa Maria Hospitals of Care and Research, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Barattoni
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bonifazi
authors.forename: Giampiero
authors.initials: G
authors.lastname: Esposito
authors.forename: Roberto
authors.initials: R
authors.lastname: Coppola
authors.forename: Georges
authors.initials: G
authors.lastname: Popoff
authors.forename: Mauro
authors.initials: M
authors.lastname: Lamarra
authors.forename: Marcio
authors.initials: M
authors.lastname: Scorcin
authors.forename: Ernesto
authors.initials: E
authors.lastname: Greco
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Argano
authors.forename: Claudio
authors.initials: C
authors.lastname: Zussa
authors.forename: Donald
authors.initials: D
authors.lastname: Cristell
authors.forename: Francesco
authors.initials: F
authors.lastname: Bartolomucci
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001026:Coronary Artery Bypass; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome