Adult Cardiac surgery in the elderly (octogenarians and above) - are we getting better?

Abstract

Background In our modern times there's an ever going increase in the average life expectancy. With this increase of age there is a higher incidence of cardiovascular disease and more elderly patients require cardiac surgery nowadays (1). Medical advances in the pre-and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and have a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery and major surgery of the aorta are performed in elderly patients with a satisfactory outcome (2,3). Nevertheless, this cohort of patients has an inherent potential of developing higher morbidity rates and the risk for these patients is only acceptable in the absence of comorbidities (4). It is only with proper patient selection criteria, attention to details and a high quality surgery that we would expect to see a satisfactory outcome. The care of elderly cardiac surgery patients is a multidisciplinary team approach requiring the cooperation of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a specific treatment for each individual patient. Methods This study is representative of our practice in Blackpool Victoria hospital NHS foundation trust, UK. Our institutional database was used to identify patients aged 80 or above undergoing cardiac surgery between June 1996 and June 2013. Our aim was to asses our unit's results in terms of morbidity and mortality over the last 4 years in this frail group of patients and compare the results to our early practice. We divided our patients into two groups, group 1 (June1996-Dec.2008; n=472) compared to Group 2(Jan.2009-June.2013; n=607). Long-term survival was ascertained using NHS tracing-service. Results Descriptive and Preoperative results: Results showed that the current study population had a mean age of those in group 1 being 82.23 ± 2.33 vs 82.89 ± 2.66 in group 2 p=< 0.01 (Table 1). The age distribution is shown in (figure 1). The female population were less frequent in group 2 than group 1 38.7% (n=235) compared to 47.2% (n=223) respectively. Both groups had similar preoperative morbidity with regards to diabetes, renal dysfunction and LV functions (Table 1). Hypertension and pulmonary problems were significantly lower in group