Twenty years of cardiac surgery in patients aged 80 years and older: risks and benefits.
BACKGROUND
Patients aged 80 years and older who require cardiac surgical procedures are an increasing population and usually present with considerable comorbidity. Detailed operative risk stratification versus long-term survival and quality of life after surgery is mandatory.


METHODS
A retrospective analysis was performed on 1,003 patients aged 82.3 years (range, 80 to 94 years) who underwent aortic valve replacement (n = 303), coronary artery bypass grafting (n = 403), or aortic valve replacement with coronary artery bypass grafting (n = 297) between 1987 and 2006. Preoperative data, operative outcome, long-term survival, and predictors for early and late mortality were analyzed. Furthermore, the Short Form 36 Health Status questionnaire was used to evaluate the quality of life.


RESULTS
Overall in-hospital mortality was 7.1%. Overall actuarial survival at 1, 5, and 10 years was 81.6% ± 1.2%, 60.4% ± 1.9%, and 23.3% ± 2.6% (mean survival time, 6.25 ± 0.2 years) and showed no significant difference compared with an age- and sex-matched general population. Multivariate analysis showed that preoperative creatinine concentration greater than 1.3 mg/dL (p < 0.001), preoperative atrial fibrillation (p < 0.005), and postoperative prolonged ventilation (p < 0.001) were independent predictors for poor long-term survival. The physical health summarized score of the Short Form 36 Health Status questionnaire was significantly increased in the study population compared with a German standard population aged 80 years and older (p < 0.05).


CONCLUSIONS
Despite an increased operative mortality, octogenarians showed a considerable quality of life and an excellent long-term survival. To further improve surgical outcome in octogenarians, patient selection should be done with consideration of the identified independent preoperative risk factors.
Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany. krane@dhm.mhn.de
Markus
M
Krane
Bernhard
B
Voss
Andreas
A
Hiebinger
Marcus Andre
MA
Deutsch
Michael
M
Wottke
Alexander
A
Hapfelmeier
Catalin C
CC
Badiu
Robert
R
Bauernschmitt
Rüdiger
R
Lange
D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D018579:Patient Selection; D011159:Population Surveillance; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality; D011788:Quality of Life; D012086:Reoperation; D012308:Risk Management / Q000379:methods*; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome