Cardiac surgery for octogenarians--a suitable procedure? Twelve-year operative and post-hospital mortality in 641 patients over 80 years of age.

摘要

OBJECTIVES: The increase in life expectancy as a result of therapeutic improvements subsequently leads to a large number of patients with advanced age. The aim of this study was to review the 30-day mortality and mid-term outcome of octogenarians undergoing coronary artery bypass grafting (CABG) or valve replacement (AVR/MVR). METHODS: The data of 641 patients with a mean age of 82.6 years (range 80.0 - 92.6), operated between 9/93 and 12/05, were reviewed. 432 patients underwent CABG, 188 had AVR and 21 had MVR. We analysed peri-/postoperative mortality and clinical outcomes. Follow-up was obtained by phone contact with patients or their physician. Mid-term survival was determined for the whole population by the Kaplan-Meier method; peri- and postoperative risk factor analysis was done using logistic regression. Follow-up ranged from 0.1 to 11.8 years (mean 3.6 +/- 2.6) and was complete for 99%. RESULTS: We observed a perioperative mortality of 8.8% for CABG, 4.8% for AVR and 9.5% for MVR. Perioperative mortality was strongly associated with urgent/emergent operations (P < 0.03), poorer clinical status (P < 0.03), renal dysfunction (P < 0.05) and male gender (P < 0.04). Actuarial survival after 3, 5 and 8 years was as follows: CABG 78%, 66% and 44%; AVR 79%, 68% and 38%; MVR 76%, 61% and 23%. The mean NYHA functional class for survivors improved in the group of patients with CABG from 2.7 to 2.0 (P < 0.03), in the AVR group from 2.8 to 2.0 (P < 0.03), and in the MVR group from 2.9 to 2.3 (P < 0.05). More than 80% of all surviving patients live at home, either alone or with their family. CONCLUSION: In our cohort of octogenarians, cardiac surgery was found to be associated with an acceptable, although increased perioperative mortality. Despite the enhanced perioperative risk, the clinical benefit, as verified by improved functional status and satisfactory mid-term survival rates, justifies surgery in these patients with advanced age.