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DOI: 10.1055/s-2004-816610
Cardiac surgery in octogenerians – Uncalculatable risk or justified therapy? Retrospective analysis of 590 patients over 80 years of age
Objectives: The medical progress in the last decade, responsible for an increasing life expectancy, results in a large number of patients with advanced age requiring cardiac surgery. Aim of this study was to review 30-day-mortality and the early outcome of octogenerians with CABG and/or valve-replacement.
Material and Methods: We evaluated 590 patients (304 male, 286 female) mean age of 82,7 years (?=82,7;?=82,5), operated between 9/93–7/03. 313 patients received CABG, 166 valve-replacement and 111 combined procedures. We analyzed preoperative status (urgent/emergent), operative data and ICU-/in-hospital-stay.
Results: Number of anastomosis accounted 2,95 grafts./pts mean. 85 pts.(14,4%) were operated urgent/emergent. ITA incidence was 82,6%, bilateral ITA (BITA) was performed in 44,5% in isolated CABG. For combined procedures ITA incidence amounts 63,9%, BITA 14,4%. We observed an overall 30-day-mortality rate of 10,8% (n=64), for isolated CABG 10,6% (n=33), for combined procedures 18,0% (n=20) and 6,6% (n=11) for isolated valve-replacement. Mortality-rate in isolated CABG is related significantly to reduced left ventricular function (EF51,70±17,7%; p<0,017), impaired clinical status (NYHA III-IV; p<0,008) and urgent/emergent intervention (21,3% mortality-rate; p<0,01). Prolonged cardiopulmonary-bypass-time (mean 106,1min; p<0,01) and duration of surgery (mean 200min; p<0,02) could be identified as significant risk factors. For combined procedures we evaluated a similar tendency without significance. X-clamb-time >90min was related to a higher mortality (<90min. 9,4%, >90min 37,5% and >120min 30,7%) for all groups. 88,3% of all patient were extubated <24h, the total in-hospital-stay was 9,1 days mean.
Conclusions: Cardiac surgery in octogenarians can be performed with an acceptable risk. Urgent/emergent intervention, reduced EF, prolonged duration of surgery and X-clamb-time could be identified as an evident predictor for an increased 30-day-mortality.