Cardiac surgery in octogenarians

Background

Cardiovascular disease is the leading cause of morbidity and mortality among the elderly, and the rate of invasive cardiovascular procedures in this population is rising, including cardiac surgery (CS). The goal of this study was to analyze the clinical characteristics and outcomes of CS in octogenarians.

Methods

An analysis of consecutive CS in a single-center tertiary hospital over a 30-month period.

Results

Among 504 consecutive CS, 30 patients (6%) were older than 80 years (group O, age 83 ± 3). They were compared with a control group of 60 patients younger than 65 years (group Y, age 52 ± 10) whose demographic characteristics were paired 2:1. Eighty-three percent of group O were operated on because of an unstable clinical condition versus 28% of group Y (P = 0.02). Preoperative left ventricular dysfunction was present in 43% of group O and 30% of group Y (P = 0.06). CABG without extracorporeal circulation was performed in 21% of group O and 17% of group Y (P = 0.70). A pulmonary artery catheter, intraortic balloon pump, and pacemaker were utilized in 6%, 0%, and 2% of group Y, and in 20%, 7%, and 13% of group O, respectively (P = 0.009). Severe bleeding and intraoperative death occurred in 7% and 10% of cases in group O, and none in group Y (P = 0.008). The times of operation, extracorporeal circulation, anoxia, and time to extubation were all longer in group O (P = 0.004). Utilization of vasoactive drugs was necessary in 36% of group Y, and in 61% of group O (P = 0.005). Lengths of stay in the ICU, semi-intensive care, and hospitalization were all more prolonged in group O. Pulmonary edema, atrial fibrillation, vasoplegia, and need for dialysis were more common in group O.

Conclusions

CS in octogenarians is usually performed because of an unstable clinical condition, in patients with left ventricular dysfunction. A significant number is performed without extracorporeal circulation. Hemodynamic support is frequently necessary. Although lengths of operation and of hospitalization are more prolonged and postoperative complications are more frequent, a favorable result can be expected in a significant number of patients.