Purpose: We aimed to evaluate the early outcome of cardiac surgery in patients ≥80 years old and their medium term survival.Methodology: A retrospective study was performed and all patients ≥80 years old that have undergone cardiac surgery between April 2008 and April 2016 at our institute were included. Data for all patients were collected prospectively as part of a national database. A dataset of patient demographics, perioperative data, and survival data were collected.Results: During the study period, a total of 2,627 patients underwent cardiac surgery, of which, 279 patients were ≥80 years old. Six patients (2.2%) were ≥90 years. Average age was 83 ± 2 years and 66% were males. Isolated CABG (34%) followed by combined AVR and CABG (24%) were the commonest operations performed. Redo cardiac surgery was performed in 7% of patients. The median time of mechanical ventilation was 13 h (IQR: 9 h) and the median ICU stay was 24 h (IQR: 27 h). The median length of hospital stay was 8 days. Cerebrovascular accident occurred in 5 patients (1.8%) and 7 patients (2.5%) required renal replacement therapy. The overall early mortality was 2.9% (1.0% for isolated CABG and 5.1% for isolated AVR). Multivariate analysis confirmed new renal failure as an independent risk factor for early mortality (p < 0.001). Kaplan-Meier analysis estimated the mean survival of 5.7 years (95%CI: 5.1-6.2) after operation. The 8-year survival was 43%. Multivariate analyses showed new renal failure (p = 0.001) and stroke (p = 0.024) as independent risk factors for medium-term mortality.Conclusion: Cardiac surgery can be safely performed in carefully selected octogenarians with acceptable early morbidity and mortality as well as reasonable medium-term survival.
Introduction: Sutureless Aortic Valve Replacement has been introduced to minimise the cardiopulmonary bypass (CPB) and cross clamp (XC) duration, in an attempt to improve the surgical outcome, particularly in high risk patients. Our aim was to review our midterm experience with this type of valve. Methods: From August 2011 to September 2014, retrospective data of 66 patients was reviewed. All patients had Sutureless AVR with or without a concomitant procedure. Of these, 60 patients received a Perceval (Sorin Group, Saluggia, Italy) prosthesis, 2 received an Intuity (Edwards Lifesciences Corporation, Irvine, CA) valve and 4 patients underwent Sutureless AVR with the 3 F Enable aortic (Medtronic, Minneapolis, MN) prosthesis. Ten were redo operations (15.1%). Median Age was 78 (range is 34-88). Mean logistic Euroscore was: 13.1 AE 10.8 (SD). Mean echocardiographic follow up was 4 months (range 0-31). Isolated AVR was performed in 40 patients and 26 patients underwent concomitant procedures. Results: Mean XC and CPB times for isolated AVR were 33 and 50 minutes respectively. Thirty-day mortality was 6.15%. The incidence of stroke and transient neurological complications was 4.5% each and that of a permanent pacemaker insertion was 7.5%. Two patients had moderate valvular regurgitation intraoperatively (3%). No significant paravalvular leak occurred in any patient. Conclusion: Sutureless AVR can be done safely and effectively and is associated with shorter bypass and cross clamp times, and an acceptable complication rate in high risk patients.
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