Short-term and long-term results of cardiac surgery in elderly and very elderly patients.
OBJECTIVE
Cardiac operations in elderly patients are increasingly frequent and imply major clinical, ethical, and economic issues. Operative and 5-year results of cardiac operations in patients aged 79 years or more are known in limited series, and a debate is ongoing on the appropriateness of selection of patients for surgery.


METHODS
We retrospectively reviewed our experience in 6802 patients aged 79 years or more who had received a cardiac operation. Surgical candidates were selected according to functional status, crude operative risk, and social context and were managed according to a multimodality protocol.


RESULTS
Mean age was 82 years and surgery was nonelective in 1613 cases (23.5%, 31 salvage). Procedures consisted of valve replacement (aortic, 2817; mitral, 532; and tricuspid, 2 cases), valve repair (aortic, 66; mitral, 532; and tricuspid, 232 cases), coronary bypass grafting (12,034 coronary vessels bypassed), and replacement of the thoracic aorta (ascending, 315; arch, 28 cases). Overall operative mortality was 3.4%. Nonelective presentation, need for aortic counterpulsation, cardiopulmonary bypass time, blood transfusion, depressed systolic function, and chronic lung disease predicted operative mortality. Five-year cumulative mortality was 7.5%. Poor systolic function, previous myocardial infarction, and combined coronary/mitral surgery predicted late mortality. The operative risk of nonagenarians operated on electively did not differ from that of risk-matched octogenarians.


CONCLUSIONS
Cardiac surgery in elderly and very elderly patients can be performed with acceptable mortality provided that accurate selection and a multifactorial risk evaluation are adopted. Whenever possible, nonelective operations should be avoided and earlier surgery should be encouraged. Five-year survival and functional recovery are good.
Speziale
Giuseppe
G
Cardiac Surgery Department of GVM Hospitals of Care and Research, Bari, Italy.
Nasso
Giuseppe
G
Barattoni
Maria Cristina
MC
Esposito
Giampiero
G
Popoff
Georges
G
Argano
Vincenzo
V
Greco
Ernesto
E
Scorcin
Marcio
M
Zussa
Claudio
C
Cristell
Donald
D
Coppola
Roberto
R
Chierchia
Sergio
S
Marchese
Alfredo
A
Caldarola
Pasquale
P
Fattouch
Khalil
K
Tavazzi
Luigi
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome