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European Heart Journal 2001 22(14):1235-1243; doi:10.1053/euhj.2000.2443
Copyright © 2001 by the European Society of Cardiology.
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Cardiac surgery in octogenarians. Peri-operative outcome and long-term results

P Kolha,f1, A Kerzmanna, L Lahayea, P Gerardb and R Limeta

a Cardiothoracic Surgery Department, University Hospital of Liège, Liège, Belgium
b Department of Biostatistics, University Hospital of Liège, Liège, Belgium

revised August 31, 2000; accepted September 6, 2000

Abstract

Aims Because the elderly are increasingly referred for operation, we reviewed the results of cardiac surgery in patients of 80 years or older.

Methods and Results Records of 182 consecutive octogenarians who had had cardiac operations between 1992 and 1998 were reviewed. Follow-up was 100% complete. Seventy patients had coronary grafting (CABG), 70 aortic valve replacement, 30 aortic valve replacement+CABG, and 12 mitral valve repair/replacement. Rates of hospital death, stroke, and prolonged stay (>14 days) were as follows: CABG: 7 (10%), 2 (2·8%) and 41 (58%); aortic valve replacement: 6 (8·5%), 2 (2·8%) and 32 (45·7%); aortic valve replacement+CABG: 8 (26·5%), 1 (3·8%) and 14 (46·6%); mitral valve repair/replacement: 3 (25%), 1 (8·3%) and 5 (41·6%). Multivariate predictors (P<0·05) of hospital death were New York Heart Association functional class, urgent procedure, prolonged cardiopulmonary bypass time, and, after aortic valve replacement, previous percutaneous aortic valvuloplasty. Ascending aortic atheromatous disease was predictive of stroke, while pre-operative myocardial infarction was predictive of prolonged hospital stay. Actuarial 5-year survival was as follows: CABG, 65·8±8·8%; aortic valve replacement, 63·6±7·1%; aortic valve replacement+CABG, 62·4±6·8%; mitral valve repair/replacement, 57·1±5·6%; and total, 63·0±5·6%. Multivariate predictors of late death were pre-operative myocardial infarction, and urgent procedure. Ninety percent of long-term survivors were in New York Heart Association class I or II, and 87% believed having a heart operation after age 80 years was a good choice.

Conclusion Cardiac operations are successful in most octogenarians with increased hospital mortality, and longer hospital stay. Long-term survival and quality of life are good.

Key Words: Aortic valve, cardiac surgery, octogenarians, quality of life

f1 Correspondence: Philippe H. Kolh, MD, Cardiothoracic Surgery Department, University Hospital of Liège, B 35 Sart Tilman, 4000 Liège, Belgium.

References

  1. Statistical Abstract of the United States/1991 (111th edn), Washington, DC, Department of Commerce, US Bureau of the Census, 1991, 81
  2. National Center for Health Statistics, Vital statistics of the United States, 1989: Vital health statistics: vol 2, Washington, DC, US Government Printing Office, 1992, 11
  3. National Center for Health Statistics, Current estimates from the National Health Interview Survey, 1989: Vital health statistics, series 10, Washington, DC, US Government Printing Office, 1990
  4. Freeman WK, Schaff HV, O'Brien PC, Orzulak T, Naessens J, Tajik A. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol. 1991;18:29–35[Abstract]
  5. Tsai TP, Nessim S, Kass RM. Morbidity and mortality after coronary artery bypass in octogenarians. Ann Thorac Surg. 1991;51:983–986[Abstract]
  6. Culliford AT, Galloway AC, Colvin S. Aortic valve replacement for aortic stenosis in patients aged 80 years and over. Am J Cardiol. 1991;67:1256–1260[CrossRef][ISI][Medline]
  7. Kleikamp G, Minami K, Breymann T. Aortic valve replacement in octogenarians. J Heart Valve Dis. 1992;1:196–200[Medline]
  8. Iskandrian AS, Hakki AH. Age-related changes in left ventricular diastolic performance. Am Heart J. 1986;112:75–78[CrossRef][ISI][Medline]
  9. Iskandrian AS, Hakki AH. The effects of aging after coronary arterial bypass grafting on the regulation of cardiac output during upright exercise. Int J Cardiol. 1985;7:347–360[CrossRef][ISI][Medline]
  10. Rodeheffer RJ, Gerstenblith G, Becker LC, Fleg JL, Weisfeldt ML, Lakatta EG. Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation. 1984;69:203–213[Abstract/Free Full Text]
  11. Statistical Abstract of the United States/1994 (114th edn), Washington, DC, Department of Commerce, US Bureau of the Census, 1994, 84
  12. Edmunds LHJ, Stephenson LW, Edie RN, Ratcliffe MB. Open-heart surgery in octogenarians. N Engl J Med. 1988;319:131–136[Abstract]
  13. Rich MW, Sandza JG, Kleiger RE, Connors JP. Cardiac operations in patients over 80 years of age. J Thorac Cardiovasc Surg. 1985;90:56–60[Abstract]
  14. Horvath KA, DiSesa VJ, Peigh PS, Couper GS, Collins JJJ, Cohn LH. Favorable results of coronary artery bypass grafting in patients older than 75 years [see comments]. J Thorac Cardiovasc Surg. 1990;99:92–95[Abstract]
  15. Craver JM, Goldstein J, Jones EL, Knapp WA, Hatcher CRJ. Clinical, hemodynamic, and operative descriptors affecting outcome of aortic valve replacement in elderly versus young patients. Ann Surg. 1984;199:733–741[ISI][Medline]
  16. Elayada MA, Hall RJ, Reul RM. Aortic valve replacement in patients 80 years and older: operative risks and long-term results. Circulation. 1993;88:11–16[Abstract/Free Full Text]
  17. Tseng EE, Lee CA, Cameron DE. Aortic valve replacement in the elderly: Risk factors and long-term results. Ann Surg. 1997;225:793–804[CrossRef][ISI][Medline]
  18. Galloway AC, Colvin S, Grossi EA. Ten-year experience with aortic valve replacement in 482 patients 70 years of age or older: operative risk and long-term results. Ann Thorac Surg. 1990;49:84–93[Abstract]
  19. Akins CW, Daggett WM, Vlahakes GJ. Cardiac operations in patients 80 years old and older. Ann Thorac Surg. 1997;64:606–615[Abstract/Free Full Text]
  20. Straumann E, Kiowski W, Langer I. Aortic valve replacement in elderly patients with aortic stenosis. Br Heart J. 1994;71:449–453[Abstract/Free Full Text]
  21. Chocron S, Etievent JP, Viel JF. Aortic valve replacement in the elderly: a comparative assay of potential risk factor modification. J Heart Valve Dis. 1995;4:268–273[Medline]
  22. Robicsek F, Harbold NBJ, Daugherty HK. Balloon valvuloplasty in calcified aortic stenosis: a cause for caution and alarm. Ann Thorac Surg. 1988;45:515–525[Abstract]
  23. Roger V, Tajik A, Reeder G. Effect of Doppler echocardiography on utilization of hemodynamic cardiac catheterization in the preoperative evaluation of aortic stenosis. Mayo Clin Proc. 1996;71:141–149[ISI][Medline]
  24. Iskandrian AS, Segal B. Should cardiac surgery be performed in octogenarians? J Am Coll Cardiol. 1991;18:36–37[ISI][Medline]
  25. Culliford AT, Galloway AC, Colvin S. Cardiac surgery in octogenarians: do the risks exceed the benefit? Am J Geriatr Cardiol. 1992;1:15–25[Medline]
  26. Frank S, Johnson A, Ross J. Natural history of valvular aortic stenosis. Br Heart J. 1973;35:41–46[Free Full Text]
  27. Cribier A, Savin T, Saoudi N, Rocha P, Berland J, Letac B. Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement. Lancet. 1986;330:63–67
  28. McKay RG. Balloon aortic valvuloplasty in 285 patients: initial results and complications (Abstr). Circulation. 1988;78:594
  29. Jamieson W, Burr LH, Munro AI, Miyagishima RT, Gerein AN. Cardiac valve performance in the elderly: clinical performance of biologic prostheses. Ann Thorac Surg. 1989;48:173–185[Abstract]
  30. Borkon AM, Soule LM, Baughman KL. Aortic valve selection in the elderly patient. Ann Thorac Surg. 1988;46:270–277[Abstract]
  31. Fiore AC, Naunheim KS, Barner HB. Valve replacement in the octogenarian. Ann Thorac Surg. 1989;48:104–108[Abstract]
  32. Azariades M, Fessler CL, Ahmad A, Starr A. Aortic valve replacement in patients over 80 years of age: a comparative standard for balloon valvuloplasty. Eur J Cardiothorac Surg. 1991;5:373–377[Abstract]
  33. Aranki SF, Rizzo RJ, Couper GS. Aortic valve replacement in the elderly. Effect of gender and coronary artery disease on operative mortality. Circulation. 1993;88:II17–II23
  34. Kouchoukos NT, Lell WA, Rogers WJ. Combined aortic valve replacement and myocardial revascularization. Ann Thorac Surg. 1983;197:721–727
  35. Lytle BW, Cosgrove DM, Loop FD. Replacements of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients. Circulation. 1983;68:1149–1162[Abstract/Free Full Text]

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