Early and Late Results of Cardiac and Thoracic Aortic Surgery in Octogenarians-Comparison With High-Risk Younger Patients-

Abstract

Forty octogenarians (OCTO) undergoing a variety of cardiac and thoracic aortic surgeries using cardiopulmonary bypass (CPB) between 1994 and 2002 were retrospectively studied. The results were compared with those of high-risk younger patients aged less than 60 years (YOUNG) (n=89). All patients had an expected operative mortality of EuroSCORE 5 and over. The EuroSCORE score was 9.9+/-3.3 (range, 5-18) in the OCTO group and 6.8+/-2.3 (range, 5-16) in the YOUNG patients (p<0.0001). There were 4 (10%) and 10 (11%) hospital deaths, respectively (p>0.99). Major postoperative complications occurred in 50% of the OCTO and 36% of the YOUNG patients (p=0.17). There were 10 and 7 late deaths, respectively. Actuarial survival including hospital death was significantly lower in the OCTO group than in the YOUNG (p=0.033). Actuarial survival was significantly higher in female octogenarians than in male (p=0.046). The overall 3-year survival rate was 88+/-8% and 64+/-11%, respectively. Multivariate analysis showed that predictors of late death were male gender (p=0.0005) and a high EuroSCORE (p=0.0010). Cardiac and thoracic aortic surgery using CPB can be performed in octogenarians with an acceptable hospital mortality rate and gratifying medium-term survival results.

The logistic EuroSCORE predicts the hospital mortality of the thoracic aortic surgery in consecutive 327 Japanese patients better than the additive EuroSCORE

“…A female sex, however, was found to be a factor for a lower mortality rate in our study. Although a female gender has been reported to be a significant risk factor for hospital mortality in the original report [7], Kawachi et al [6] reported no significant differences in the hospital mortality and morbidity between the two genders, and female octogenarians have also shown a significantly better actuarial survival than males [8].…”

Clinical Outcome of Cardiac Surgery in Octogenarians

“…However, the total number of patients was small and the operative mortality in that study was higher than those rates that were reported in previous studies. Kawachi et al have recently reported good early and late results for cardiac and thoracic surgery in 40 Japanese octogenarians, of which 9 cases (23%) were surgeries on the thoracic aorta (9). In our study, the operative mortality was 5% (1/20), which was a rate comparable with that observed in previous studies, and the cardiac long term survival of our study was excellent.…”

Pathophysiology of Aortic Stenosis and Approach to Treatment With Percutaneous Valve Implantation

“…for TAVI, the EuroScore can be used to stratify surgical risk in octogenarians undergoing aortic surgery, 21 although the limitations of the score index are well known.…”