Original Articles
Cardiac Operations in Patients 80 Years Old and Older

Presented at the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.
https://doi.org/10.1016/S0003-4975(97)00615-2Get rights and content

Abstract

Background. Because the elderly are increasingly referred for operation, we reviewed results with cardiac surgical patients 80 years old or older.

Methods. Records of 600 consecutive patients 80 years old or older having cardiac operations between 1985 and 1995 were reviewed. Follow-up was 99% complete.

Results. Two hundred ninety-two patients had coronary grafting (CABG), 105 aortic valve replacement (AVR), 111 AVR + CABG, 42 mitral valve repair/replacement (MVR) ± CABG, and 50 other operations. Rates of hospital death, stroke, and prolonged stay (>14 days) were as follows: CABG: 17 (5.8%), 23 (7.9%) and 91 (31.2%); AVR: 8 (7.6%), 1 (1.0%), and 31 (29.5%); AVR + CABG: 7 (6.3%), 12 (10.8%), and 57 (51.4%); MVR ± CABG: 4 (9.5%), 3 (7.1%), and 16 (38.1%); other: 9 (18.0%), 3 (6.0%), and 23 (46.0%). Multivariate predictors (p < 0.05) of hospital death were chronic lung disease, postoperative stroke, preoperative intraaortic balloon, and congestive heart failure; predictors of stroke were CABG and carotid disease; and predictors of prolonged stay were postoperative stroke and New York Heart Association class. Actuarial 5-year survival was as follows: CABG, 66%; AVR, 67%; AVR + CABG, 59%; MVR ± CABG, 57%; other, 48%; and total, 63%. Multivariate predictors of late death were renal insufficiency, postoperative stroke, chronic lung disease, and congestive heart failure. Eighty-seven percent of patients believed having a heart operation after age 80 years was a good choice.

Conclusions. Cardiac operations are successful in most octogenarians with increased hospital mortality, postoperative stroke, and longer hospital stay. Long-term survival is largely determined by concurrent medical diseases.

Section snippets

Patients

A computerized data registry of all cardiac surgical patients at the Massachusetts General Hospital was used to identify all patients 80 years old or older having a major cardiac surgical operation between January 1985 and August 1995. Records of 600 consecutive patients were retrospectively reviewed by trained research personnel for demographic information, clinical and catheterization findings, operative characteristics, and results.

Unstable angina pectoris was defined as either (1) new onset

Results

The annual incidence of cardiac operations in patients 80 years old and older is demonstrated in Fig. 1, along with the annual hospital mortality rate.

The distribution of important demographic and clinical risk factors for the patients is shown in Table 1. The age range of our patients was 80 to 94 years, with 8 patients being age 90 years or older.

Significant features of the patients’ clinical cardiac histories are recorded in Table 2. During preoperative evaluation 52 patients (9%)

Comment

Until the middle of the 1980s performing cardiac surgical operations on octogenarians was an uncommon occurrence, largely because of theoretical concerns about an elderly person’s ability to tolerate cardiopulmonary bypass, apprehension about the general quality of tissues in octogenarians, fear of multisystem disease in older patients, and incomplete appreciation of the life expectancy of patients who have reached the age of 80 years. However, in the past decade the number of octogenarians

Acknowledgements

This study was supported in part by a grant from the John F. Welch/GE Fund for cardiac surgical research.

We express our appreciation to Barbara J. Akins, BSN, and Annetta L. Boisselle, BSN, for their help in data acquisition and management, and to John B. Newell, Director of the Cardiac Computer Center, Massachusetts General Hospital, for his assistance in the statistical evaluations.

References (19)

There are more references available in the full text version of this article.

Cited by (0)

View full text
Copyright © 1997 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.