Heart 1999;82:134-137 ( August )

Good outcomes from cardiac surgery in the over 70s

A M Zaidi, A P Fitzpatrick, D J M Keenan, N J Odom, G J Grotte

Manchester Heart Centre, The Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

Correspondence to: Dr Zaidi. email: amir{at}mhc.cmht.nwest.nhs.uk

Accepted for publication 1 March 1999

OBJECTIVETo determine the early mortality and major morbidity associated with cardiac surgery in the elderly.
DESIGNRetrospective case record review study of 575 patients  70 years old who underwent cardiac surgery at the Manchester Heart Centre between January 1990 and December 1996.
SETTINGRegional cardiothoracic centre.
SUBJECTSPatients  70 years old who underwent cardiac surgery.
MAIN OUTCOME MEASURESComparison of 30 day mortality and incidence of major morbidity between patients  70 years old and patients < 70 years old.
RESULTSOf 4395 cardiac surgical operations, 575 operations (13.1%) were in patients aged  70 years (mean (SD) 73.1 (3.2) years). The proportion of elderly patients rose progressively from 7.9% in 1990 to 16.5% in 1996. 334 patients (58.1%) had coronary artery bypass grafting alone, 91 patients (15.8%) had valve surgery alone, and 129 patients (22.4%) had combined valve surgery and bypass grafting. For isolated coronary artery bypass grafting, 30 day mortality in patients  70 years was 3.9% compared with 1.3% in patients < 70 years (p < 0.001). 30 day mortality for isolated valve surgery in patients  70 years was 7.7%. Isolated aortic valve replacement was the most common valvar procedure in patients  70 years and carried the lowest mortality (4.3%). Additional coronary artery bypass grafting increased the mortality rate in patients  70 years to 9.3% for all valve surgery and to 8.0% for aortic valve replacement. Major morbidity in patients  70 years was low for all procedure types (stroke 1.9%, acute renal failure requiring dialysis 1.6%, perioperative myocardial infarction 0.5%).
CONCLUSIONSEarly mortality and major morbidity is low for cardiac surgery in elderly patients. Concerns over the risk of cardiac surgery in the elderly should not prevent referral, and elderly patients usually do well. However, unconscious rationing of health care may affect referral patterns, and studies that assess the cost effectiveness of cardiac surgery versus conservative management in such patients are lacking.


Keywords: cardiac surgery; elderly; mortality; coronary artery bypass grafting; valve replacement

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© 1999 by Heart
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