Outcome in octogenarians undergoing open heart surgery – a single center experience

Aims: Heart surgery procedures in octogenarians are steadily increasing. We reviewed our operative results of cardiac procedures in these patients and their postoperative course on intensive care unit (ICU).

Methods: In a retrospective analysis we investigated the results of 730 patients (pts.) ≥80 years (mean age 82, 8 years±4, 1) who underwent cardiac surgery in our institution. Isolated CABG operations: 78 pts. in off-pump technique, 363 pts. on cardiopulmonary bypass. Valve operations: 53 pts. undergoing mitral valve surgery, combined procedures: 236 pts. (AVR +CABG: n=215, AVR+MVR: n=21).

Results: 30-day mortality for the complete group was 5,7%. (CABG off-pump: 3,1%, CABG on bypass: 2,75%, MVR: 3,9%, AVR+CABG: 8,8%, AVR+MVR: 10,2%). Length of stay (LOS): 16,1 days±9,2, ICU stay: 8,1 days±7,8, ventilation days: 3,8±2,9. Haemodialysis was needed in 9, 8% of pts. for a mean length of 3,7 days (pre-operative creatinine level 1,2±0,8). Psychological reversible disorders after surgery occurred in 18, 2% of pts. The incidence of stroke was 3, 6%. Multivariate analysis revealed that predictors (p<0.05) of early mortality were emergency procedure, combined valve procedures, ejection fraction (EF) <20% and prolonged cardiopulmonary bypass time.

Conclusion: Cardiac surgery procedures in elderly can be performed with an acceptable mortality and post-operative morbidity. To our mind postoperative ICU management is the crucial step for outcome and improvements on results can be anticipated here.