Good outcomes from cardiac surgery in the over 70s

Abstract

Objective-To determine the early mortality and major morbidity associated with cardiac surgery in the elderly. Design-Retrospective case record review study of 575 patients > 70 years old who underwent cardiac surgery at the Manchester Heart Centre between January 1990 and December 1996. Setting-Regional cardiothoracic centre. Subjects-Patients > 70 years old who underwent cardiac surgery. Main outcome measures-Comparison of 30 day mortality and incidence of major morbidity between patients > 70 years old and patients < 70 years old. Results-Of 4395 cardiac surgical operations, 575 operations (13.1%) were in patients aged > 70 years (mean (SD) 73.1 (3.2) years). The proportion of elderly patients rose progressively from 7.9% in 1990 to 16.5% in 1996. 334 patients (58.1%) had coronary artery bypass grafting alone, 91 patients (15.8%) had valve surgery alone, and 129 patients (22.4%) had combined valve surgery and bypass grafting. For isolated coronary artery bypass grafting, 30 day mortality in patients > 70 years was 3.9% compared with 1.3% in patients < 70 years (p < 0.001). 30 day mortality for isolated valve surgery in patients > 70 years was 7.7%. Isolated aortic valve replacement was the most common valvar procedure in patients > 70 years and carried the lowest mortality (4.3%). Additional coronary artery bypass grafting increased the mortality rate in patients > 70 years to 9.3% for all valve surgery and to 8.0% for aortic valve replacement. Major morbidity in patients > 70 years was low for all procedure types (stroke 1.9%, acute renal failure requiring dialysis 1.6%, perioperative myocardial infarction 0.5%). Conclusions-Early mortality and major morbidity is low for cardiac surgery in elderly patients. Concerns over the risk of cardiac surgery in the elderly should not prevent referral, and elderly patients usually do well. However, unconscious rationing of health care may aVect referral patterns, and studies that assess the cost eVectiveness of cardiac surgery versus conservative management in such patients are lacking. (Heart 1999;82:134-137)

Mid-term survival after cardiac surgery in elderly patients: analysis of predictors for increased mortality

“…The number of elderly patients undergoing cardiac surgery at our institution has increased from 9.5% in the financial year 1997/1998 to 15 The median age at operation in this study cohort was 77.5 years (25th and 75th percentiles: 76.2 -79.6 years); the maximum age was 92.6 years. Patient characteristics are shown in Table 1.…”

“…We have now shown that this impact is also carried on to the longevity of these patients. Patients with valve disease have been shown to suffer more postoperative complications than patients with isolated coronary disease [15]. This poorer outcome could be linked to immediate complications like stroke or renal failures that these patients sustained during the initial procedure and that this may have a mid-to long-term implication.…”

Which doctors are influenced by a patient's age? A multi-method study of angina treatment in general practice, cardiology and gerontology

“…[1][2][3] This evidence has come from registry studies, 4 policy audits, 5 analyses of patients' records 6 7 compilations of anecdotal patient reports, 8 9 population surveys, 10 11 cohort studies 12 13 and qualitative analysis of interviews.…”

Sudden cardiac death and mitral and aortic valve disease

“…К этому нужно доба-вить, что ранняя послеоперационная смерт-ность после аортального протезирования со-ставляет 2,4 %, митрального -4,3 %, многокла-панного вмешательства -8,2 % и зависит от многих причин [47]. Близкие цифры приводятся и в других исследованиях [48,49].…”