Outcomes of cardiac surgery in nonagenarians

Abstract

Background While advanced age can be considered by some a contraindication to open‐heart surgery, there is a paucity of data regarding outcomes of cardiac surgery in nonagenarians. We, therefore, sought to investigate the outcomes of nonagenarians undergoing cardiac surgery. Methods A retrospective review of our institutional Society of Thoracic Surgeons database between 1993 and 2019 was performed. Among a total of 32,421 patients who underwent open‐heart surgery, 134 patients (0.4%) were nonagenarians (50.7% females, median age 91.6 [interquartile range: 90.7–92.9]). A comparison was performed between nonagenarians and patients aged 80–89 years. A regression analysis was performed to evaluate factors associated with midterm mortality in nonagenarians. Results The incidence of cardiac surgery in nonagenarians has been stable over time, from 0.4% in (1993–2000), 0.5% in (2001–2010) to 0.4% in (2011–2019). Valve surgery and CABG+valve were higher in nonagenarians compared to octogenarians (44.8% vs. 25.6%, 39.6% vs. 30.7%, respectively), but CABG was lower (15.7% vs. 33.8%); p < .01. Urgent/emergent surgery status was similar between groups (p = .7). Operative mortality was similar in the two groups (6% vs. 4.6%, p = .5). Hospital complications were comparable between groups. Conclusion Cardiac surgery in nonagenarians can be achieved with acceptable morbidity and mortality. This study can be a benchmark for risk stratification for cardiac surgery in this high‐risk population.

Diagnosis and Management of Aortic Valvular Disease in the Elderly

“…On extended follow-up out to 15 years there was a significant difference with greater mortality in nonagenarians, which is to be expected due to lower baseline life expectancy. 63 These data again present morbidity and mortality in nonagenarians undergoing cardiac surgery that is higher than in a younger cohort, but within acceptable ranges. In this patient population, assessment of baseline functional status and postoperative expectations is of paramount importance.…”

Cardiac surgery in nonagenarians: Rethinking operative strategies in the era of TAVR and TMVR

“…As Transcatheter Aortic Valve Replacement (TAVR) has emerged in the recent era between 2011 and 2019, the incidence of Surgical Aortic Valve Replacement (SAVR) in the Mayo group of nonagenarians and octogenarians declined to 0.3%, with all of those SAVRs done in 2011. This brought operative mortality of SAVR down to 4% from 1993 to 2011, with comparable TAVR mortality of 1% from 2011 to 2019 in the reported group 20. The STS‐PROM risk scores underrepresented the 30‐day mortality in nonagenarians in this patient cohort.…”

Cardiac Surgery in Nonagenarians Following the TAVI/TMVI Era: A Multicenter 23-Year Comparative Analysis

“…Presently, studies analyzing the outcomes of these patients have not been sufficiently reported. In fact, most studies in the literature on this topic have a very limited number of patients [ 2 , 3 , 4 , 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]: from just over 10 patients [ 3 , 15 ] to a maximum of 49 [ 11 ]. Two articles present slightly more than 100 patients [ 4 , 5 ]; however, in these papers, nonagenarian patients are drawn from large national databases consisting of thousands of patients.…”

“…In fact, most studies in the literature on this topic have a very limited number of patients [ 2 , 3 , 4 , 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]: from just over 10 patients [ 3 , 15 ] to a maximum of 49 [ 11 ]. Two articles present slightly more than 100 patients [ 4 , 5 ]; however, in these papers, nonagenarian patients are drawn from large national databases consisting of thousands of patients. Thus, our study, with more than 200 patients aged over 90 enlisted, currently represents the largest case study from a single hospital group.…”

“…However, the number of patients with cardiovascular disease, including those with an indication for cardiac surgery, is also rising. Specifically, for the category of very elderly patients, various parts of the world have reported cardiac surgery performed on 90-year-old patients with acceptable results, as judged by the authors themselves in terms of morbidity and mortality, particularly for elective procedures performed early at the onset of the patient’s symptoms [ 2 , 3 , 4 , 5 ]. Regardless, the ambiguity in terms of the correct preoperative risk assessment remains, when considering all the possible alternative interventional procedures that could be performed [ 6 ].…”