Short-term and long-term results of cardiac surgery in elderly and very elderly patients

Khalil Fattouch, Sergio Chierchia, Maria Cristina Barattoni, Pasquale Caldarola, Roberto Coppola, Marcio Scorcin, Giampiero Esposito, Roberto Coppola, Alfredo Marchese, Donald Cristell, Giuseppe Nasso, Georges Popoff, Claudio Zussa, Giuseppe Speziale, Ernesto Greco, Luigi Tavazzi, Vincenzo Argano

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Abstract

Objective: Cardiac operations in elderly patients are increasingly frequent and imply major clinical, ethical, and economic issues. Operative and 5-year results of cardiac operations in patients aged 79 years or more are known in limited series, and a debate is ongoing on the appropriateness of selection of patients for surgery. Methods: We retrospectively reviewed our experience in 6802 patients aged 79 years or more who had received a cardiac operation. Surgical candidates were selected according to functional status, crude operative risk, and social context and were managed according to a multimodality protocol. Results: Mean age was 82 years and surgery was nonelective in 1613 cases (23.5%, 31 salvage). Procedures consisted of valve replacement (aortic, 2817; mitral, 532; and tricuspid, 2 cases), valve repair (aortic, 66; mitral, 532; and tricuspid, 232 cases), coronary bypass grafting (12,034 coronary vessels bypassed), and replacement of the thoracic aorta (ascending, 315; arch, 28 cases). Overall operative mortality was 3.4%. Nonelective presentation, need for aortic counterpulsation, cardiopulmonary bypass time, blood transfusion, depressed systolic function, and chronic lung disease predicted operative mortality. Five-year cumulative mortality was 7.5%. Poor systolic function, previous myocardial infarction, and combined coronary/mitral surgery predicted late mortality. The operative risk of nonagenarians operated on electively did not differ from that of risk-matched octogenarians. Conclusions: Cardiac surgery in elderly and very elderly patients can be performed with acceptable mortality provided that accurate selection and a multifactorial risk evaluation are adopted. Whenever possible, nonelective operations should be avoided and earlier surgery should be encouraged. Five-year survival and functional recovery are good. Copyright © 2011 by The American Association for Thoracic Surgery.
Lingua originaleEnglish
pagine (da-a)725-731
Numero di pagine7
RivistaJournal of Thoracic and Cardiovascular Surgery
Volume141
Stato di pubblicazionePublished - 2011

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All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Fattouch, K., Chierchia, S., Barattoni, M. C., Caldarola, P., Coppola, R., Scorcin, M., Esposito, G., Coppola, R., Marchese, A., Cristell, D., Nasso, G., Popoff, G., Zussa, C., Speziale, G., Greco, E., Tavazzi, L., & Argano, V. (2011). Short-term and long-term results of cardiac surgery in elderly and very elderly patients. Journal of Thoracic and Cardiovascular Surgery, 141, 725-731.