Fast-track intensive care procedure after cardiac surgery in the 9th decade

Objective

Outcome with fast track intensive care medicine after cardiac surgery in patients older than 80 years.

Methods

Between 7/96 and 7/97, 86 cardiac operations (3.7%) have been performed in patients older than 80 years out of an overall number of 2349 cardiac operations. Preoperative NYHA Status was III in 36.1% and IV in 46.5% of the old patients. LVEF was 49%, LVEDP 16 mmHg. Additional desaeses were: diab. mell. 23.3%, renal insufficiency 11.6%, cerebral stroke 10.5% and myocardial infarction 37.2%. Performed cardiac operations have been: CABG (61.6%), AVR (23.3%), CABG and AVR (12.8%), MVR (1.2%), CABG and MVR (1.2%) and REDO operations (4.6%). Mean time on ECC was 84 min and overall operation time was 169 min (mean). Anesthesia was conducted as balanced anesthesia with early extubation as a main aim.

Results

Patients were extubated 6 h (median) after surgery, shortest duration of ventilation was 30 min. Mean stay on ICU was 2.6 days and mean time of hospitalisation was 9.4 days. 30-day-mortality was 3.4% in the old patients and 2.2% in the overall population.

Conclusion

Fast-track procedure after cardiac surgery in the octanarian is feasible with even better results and without any additional risk than conventional intensive care procedure.