Outcome and risk factors in octogenarians undergoing open-heart surgery

Background and aim of the study: Increasing numbers of elderly (aged >80 years) patients are being referred for cardiac surgery, and results for coronary artery bypass grafting (CABG) are generally better than for combined CABG and valve replacement. Methods: During the past 55 months, 77 octogenarians underwent cardiac intervention in our institution. Forty-five patients (mean age 82.5 years) underwent CABG alone; surgery was elective in 33% of patients and 2.7 ± 1.0 grafts per patient were performed. Thirty-two patients (mean age 82.4 years) underwent combined CABG and valve surgery (28 aortic, four mitral); 2.1 ± 0.8 grafts per patient were performed and 65% of cases were emergencies. Results: In patients undergoing CABG alone, the operative mortality rate was 2% and rose to 4% (n = 2) at the end of follow up. Mean NYHA functional class improved significantly from 3.5 ± 0.5 to 1.4 ± 0.3 after surgery (p <0.05) and most patients reported marked improvement in their quality of life. In CABG + valve surgery patients, the operative mortality rate was 6% (n = 2) and reached 18% by the end of follow up. In these patients the complication rate was 24% and mean hospitalization stay 11.0 ± 2.9 days, while mean NYHA functional class improved from 3.4 ± 0.6 to 1.2 ± 0.5. Data analysis revealed that mitral regurgitation combined with coronary artery disease (p <0.03) and prolonged cross-clamping time (p <0.01) were the most important independent factors for mortality. Conclusion: This study confirms that, in selected elderly patients, combined CABG and cardiac surgery can achieve good postoperative results.