title: Cardiac reoperations in octogenarians: Do they really benefit?
abstract: OBJECTIVE
  According to the demographic development of our society, the numbers of octogenarians referred to cardiac surgery are continuously growing. Although the benefit of first-time cardiac procedures for these patients is well documented, the fate of octogenarians after redo-procedures, with special regard to long-term survival, functional status and quality of life, is poorly investigated.
  
  
  METHODS
  We retrospectively identified 84 consecutive patients aged ≥80 years, who underwent a cardiac reoperation at the department for Cardiothoracic Surgery in the Heart & Vessel Center Bad Bevensen between January 2007 and 2013. Demographic profiles as well as operative data were analyzed, and the patients were prospectively followed. Patient's functional status and quality of life were assessed with the Barthel Index, New York Heart Association class and the short form-12 questionnaire.
  
  
  RESULTS
  The mean age of the study group (61 men, 23 women) was 81.9 ± 1.9 years. Most redo-procedures were carried out after primary coronary artery bypass grafting (65%), primary aortic valve replacement (21%) and primary mitral valve replacement (6%). The most frequent actual surgical procedures were combined coronary artery bypass grafting and aortic valve replacement (26%), isolated coronary artery bypass grafting (19%), and isolated aortic valve replacement (19%). The mean length of hospital stay was 17 ± 15 days. In-hospital mortality counted for 32.1%. During follow up (29 ± 20 months) a further 19.0% of the patients died. The Barthel Index of the survivors was 89 ± 17 and their mean New York Heart Association class was 2 ± 1. A total of 93% of the patients were living at home. Summary scores of physical and mental health of the short form-12 questionnaire equalled those of an age- and sex-matched normative population.
  
  
  CONCLUSIONS
  Despite high perioperative mortality, results document a sustainable recovery of the survivors offering the prospect of a highly independent and satisfying life. Therefore, advanced age alone should not be a contraindication for redo cardiac interventions. Geriatr Gerontol Int 2016; 16: 1138-1144.
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany. deschkaheinz@hotmail.com.
authors.forename: Heinz
authors.initials: H
authors.lastname: Deschka
authors.affiliation: Department for Cardiothoracic Surgery, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Machner
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Henryk
authors.initials: H
authors.lastname: Welp
authors.affiliation: Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Angelo Maria
authors.initials: AM
authors.lastname: Dell'Aquila
authors.affiliation: Department for Cardiothoracic Surgery, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Erler
authors.affiliation: Department for Cardiothoracic Surgery, Heart & Vessel Center Bad Bevensen, Bad Bevensen, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D012086:Reoperation / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: functional status; octogenarians; operative outcomes; quality of life; redo-cardiac surgery