Non-elective cardiac surgery in octogenarians: How effective are we?

Objectives: The general assumption that nonelective cardiac procedures in octogenarians are related to poor postoperative outcomes and quality of life may lead to a non justified exclusion of elderly patients from surgical treatment. Aim of this study was to assess survival, functional outcome and quality of life (QOL) of octogenarians undergoing nonelective cardiac surgery.

Methods: Between 2009 and 2011, 62 consecutive octogenarians (mean age 83.5 ± 3.5 y) underwent urgent (n = 32) or emergent (n = 30) cardiac surgery. In 69% CABG was performed and in 24% patients underwent CABG plus valve surgery. Preoperative risk as well as postoperative course were analyzed. All discharged patients were contacted to gain information about survival, functional capacity and QOL using Barthel mobility index and SF 12 health survey questionnaire. Results were compared to age adjusted population data.

Results: In hospital mortality was 32.3% overall, 9.3% in urgent cases and 56.7% in emergent cases. After a mean follow up period of 17.5 ± 11.4 month, survival of the discharged patients was 93.1% (urgent) and 76.9% (emergency) respectively. QOL measures of the survivors were equivalent to those of the general elderly population. Functional capacity, calculated with Barthel index, was high in both groups (86 ± 13 and 81 ± 21). 92% of the patients were living at home.

Conclusions: Although nonelective cardiac surgery in the elderly is related to a high in hospital mortality, physical and psychological recovery of the survivors are encouraging. QOL equals that of the general elderly population and a good functional status offers a highly independent life. Age should not disqualify for urgent or emergent cardiac surgery.