Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Abstract

Background-Age Ͼ90 years represents in many centers an absolute contraindication to cardiac surgery. Nonagenarians are a rapidly growing subset of the population posing an expanding clinical problem. To provide helpful information in regard to this complex decision, we analyzed the operative and 5-year results of coronary and valvular surgical procedures in these patients. Methods and Results-We retrospectively reviewed 127 patients aged Ն90 years who underwent cardiac surgery within our hospital group in the period 1998 to 2008. Kaplan-Meier and multiple logistic regression analyses were performed. A longer follow-up than most published studies and the largest series published thus far are presented. Mean age was 92 years (range, 90 to 103 years). Mean logistic EuroSCORE was 21.3Ϯ6.1. Sixty patients had valvular surgery (including 11 valve repairs), 49 patients had coronary artery bypass grafting, and 18 had valvular plus coronary artery bypass grafting surgery (55 left mammary artery grafts implanted). Forty-five patients (35.4%) were operated on nonelectively. Operative mortality was 13.4% (17 cases). Fifty-four patients (42.5%) had a complicated postoperative course. There were no statistically significant differences in the rate and type of complications between patient strata on the basis of type of surgery performed. Nonelective priority predicted a complicated postoperative course. Predictors of operative mortality were nonelective priority and previous myocardial infarction. Kaplan-Meier survival estimates at 5 years were comparable between patient groups on the basis of procedure performed. Conclusions-Although the rate of postoperative complications remains high, cardiac surgery in nonagenarians can achieve functional improvement at the price of considerable operative and follow-up mortality rates. Cardiac operations in these very elderly subjects are supported if appropriate selection is made and if the operation is performed earlier and electively. Our results should contribute to the development of guidelines for cardiac operations in nonagenarians.

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

“…Previous studies involving octogenarian patients undergoing cardiac procedures had already described the lack of association of diabetes with this outcome [18][19][20][21][22][23][24]. Studying even older patients, Speziale et al [25] described the non-elective surgery and the existence of previous myocardial infarction as predictors of mortality in nonagenarian patients undergoing cardiac procedures, not observing the presence of diabetes as a risk factor for this outcome.…”

Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years

“…Many previous studies have demonstrated that cardiac surgery can be performed with acceptable results not only in octogenarians, but also in nonagenarians. [9][10][11] However, it is well known that advanced age is a risk factor for mortality, and elderly patients are more likely to suffer from postoperative complications. 2,3,8,9) Bridges, et al reported from the Society of Thoracic Surgeons National Database with a total of 662033 patients that operative mortality was 11.8% for patients more than 90 years of age, 7.1% for those 80 to 89 years, and 2.8% for those 50 to 79 years and the incidence of renal failure and prolonged ventilation was highest among patients more than 90 years of age (9.2% and 12.2%), compared with those 80 to 89 years (7.7% and 10.5%) or 50 to 79 years (3.5% and 6.0%).…”

Intervenção coronária percutânea em pacientes nonagenários

“…In the late follow-up, there were significant differences in survival free from MACE (68% vs. 91%; P < 0.001 Apesar da experiência satisfatória da intervenção coronária percutânea nos pacientes octogenários, [3][4] nos nonagenários ainda discutem-se as indicações de procedimentos mais invasivos, como a cirurgia de revascularização e também a intervenção coronária percutânea. [5][6][7] Por outro lado, não há grande quantidade de publicações de intervenção coronária percutâ-nea em nonagenários, portanto a limitação de conclusões científicas mais definitivas torna suas indicações controversas. Assim sendo, neste nosso manuscrito tentaremos não somente mostrar nossos resultados como discutir, ao lado dos dados obtidos da literatura, as indicações da intervenção coronária percutânea nesse subgrupo de pacientes.…”

“…[14][15][16] A intervenção coronária percutânea com implante de stents, pelo seu caráter menos invasivo e traumá-tico e pelos bons resultados em casos selecionados, credencia esse procedimento como importante opção no tratamento de pacientes muito idosos. 5,7,[16][17][18] …”