Cardiac surgery in octogenarians:: current situation and future perspectives

BACKGROUND AND OBJECTIVE: Increasing life expectancy make's cardiac surgery in octogenarians not very uncommon. We evaluated the characteristics and outcomes of patients aged over 80 undergoing cardiac surgery in our Centre. PATIENTS AND METHOD: We retrospectively analyzed preoperative risk factors, in-hospital morbimortality, and long term survival in 120 patients aged 80 years -mean age (standard deviation): 81.53 (1.83)- who underwent cardiac surgery between 2000 and 2005, in comparison with 2425 younger patients referred to our center during the same period. RESULTS: Preoperatively, octogenarians presented arterial hypertension, renal failure, unstable angina, left main coronary stenosis and New York Heart Association (NYHA) functional class III or IV more frequently than younger patients. Combined cardiac surgery procedures (valvular plus coronary) were also significatively higher (20% vs. 9.85%). Hospital mortality (15.8%) was twice as higher as in the non octogenarian population and postoperative intensive care units and hospital stay was longer. 45% suffered some postoperative complication. In the multivariate analysis urgent procedure, mitral valve surgery and presentation of any postoperative complication were identified as predictors of mortality, and female sex was identified as a risk factor for postoperative morbidity. Survival at one, 3 and 5 years was 91.20%, 80.73% and 69.20%, respectively. 98.7% of the patients were in I-II NYHA functional class and 92.5% satisfied with overall surgery outcome when they were interviewed. CONCLUSIONS: Despite more preoperative co-morbidity and worse functional class, cardiac surgery in octogenarians can be performed with an acceptable mortality, Our patients have a satisfactory quality of life and would undergo a cardiac surgery procedure again. Specific measurements in preoperative and immediate postoperative periods, in order to reduce higher morbidity rates, are advisable.