Carotid endarterectomy in octogenerians

Purpose: The purpose of this study was to determine the safety and efficacy of carotid endarterectomy (CEA) in octogenerians. Methods: The records of 59 CEA performed in 57 patients who were 80 yr or older between April 1993 and September 1998 were reviewed. There were 33 males and 24 females with a mean age of 82, Forty-nine procedures (83%) were performed for symptomatic carotid stenosis, The perioperative mortality and morbidity including neurological events were recorded. Long term follow-up data was also obtained. Results: There were three perioperative deaths (5.1%) and three perioperative neurological events, including one stroke (1.7%) and two transient ischemic attacks (3.4%), The combined mortality and stroke rate was 6.8%. With a mean follow-up of 25 +/- 21 months, Kaplan-Meier estimates of the 4-yr survival rate, freedom from stroke, and stroke free survival were 78, 94 and 75% respectively For comparison, during the same time period, the same group of surgeons performed 597 CEA in patients less than 80 yr of age. The perioperative mortality and stroke rate was 0.3 and 2.5% respectively, with a combined mortality and stroke rate of 2.7%. Perioperative mortality was significantly higher in patients over 80 yr of age (P < 0.01). Conclusions: CEA in octogenerians is associated with a higher mortality rate than in younger patients. However, good long term survival and freedom from stroke make CEA beneficial in octogenerians, With careful patient selection and perioperative management, CEA in octogenerians is worthwhile and should be advised in selected patients. (C) 2000 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.