Cardiac Surgery in Nonagenarians

Samuels, Louis E.; Sharma, SK; Morris, Rohinton J.; Kuretu, M.L. Ray; Grunewald, Karl; Strong, Michael D.; Brockman, Stanley K.

doi:10.1111/j.1540-8191.1996.tb00025.x

Cited by 24 publications

(11 citation statements)

References 46 publications

(2 reference statements)

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“…Operative mortality and morbidity rates were reportedly acceptable, but previous series were limited by the number of cases 5,7,8,10,11 or by the lack of follow-up data. 9 Therefore, the information currently available is still insufficient to draw definitive conclusions and to guide clinical practice.…”

Section: Clinical Perspective On P 213mentioning

confidence: 99%

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Saglio¹,

Nasso²,

Barattoni³

et al. 2010

Circulation

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Background-Age Ͼ90 years represents in many centers an absolute contraindication to cardiac surgery. Nonagenarians are a rapidly growing subset of the population posing an expanding clinical problem. To provide helpful information in regard to this complex decision, we analyzed the operative and 5-year results of coronary and valvular surgical procedures in these patients. Methods and Results-We retrospectively reviewed 127 patients aged Ն90 years who underwent cardiac surgery within our hospital group in the period 1998 to 2008. Kaplan-Meier and multiple logistic regression analyses were performed. A longer follow-up than most published studies and the largest series published thus far are presented. Mean age was 92 years (range, 90 to 103 years). Mean logistic EuroSCORE was 21.3Ϯ6.1. Sixty patients had valvular surgery (including 11 valve repairs), 49 patients had coronary artery bypass grafting, and 18 had valvular plus coronary artery bypass grafting surgery (55 left mammary artery grafts implanted). Forty-five patients (35.4%) were operated on nonelectively. Operative mortality was 13.4% (17 cases). Fifty-four patients (42.5%) had a complicated postoperative course. There were no statistically significant differences in the rate and type of complications between patient strata on the basis of type of surgery performed. Nonelective priority predicted a complicated postoperative course. Predictors of operative mortality were nonelective priority and previous myocardial infarction. Kaplan-Meier survival estimates at 5 years were comparable between patient groups on the basis of procedure performed. Conclusions-Although the rate of postoperative complications remains high, cardiac surgery in nonagenarians can achieve functional improvement at the price of considerable operative and follow-up mortality rates. Cardiac operations in these very elderly subjects are supported if appropriate selection is made and if the operation is performed earlier and electively. Our results should contribute to the development of guidelines for cardiac operations in nonagenarians.

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Section: Clinical Perspective On P 213mentioning

confidence: 99%

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Saglio¹,

Nasso²,

Barattoni³

et al. 2010

Circulation

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“…Many previous studies have demonstrated that cardiac surgery can be performed with acceptable results not only in octogenarians, but also in nonagenarians. [9][10][11] However, it is well known that advanced age is a risk factor for mortality, and elderly patients are more likely to suffer from postoperative complications. 2,3,8,9) Bridges, et al reported from the Society of Thoracic Surgeons National Database with a total of 662033 patients that operative mortality was 11.8% for patients more than 90 years of age, 7.1% for those 80 to 89 years, and 2.8% for those 50 to 79 years and the incidence of renal failure and prolonged ventilation was highest among patients more than 90 years of age (9.2% and 12.2%), compared with those 80 to 89 years (7.7% and 10.5%) or 50 to 79 years (3.5% and 6.0%).…”

Section: Discussionmentioning

confidence: 99%

Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years

Kamiya

Tanzeem

Akhyari

et al. 2014

Ann Thorac Cardiovasc Surg

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“…Three reports [8,10,13] from a single institution covered overlapping time periods and could not be collated, so the largest series was chosen [10] . It was possible to combine the data in 2 reports from another centre [9,11] . Two papers dealt with outcomes in nonagenarian patients covering 2 different time periods at the same institution [14,19] .…”

Section: Literature Reviewmentioning

confidence: 99%

“…Twelve single-centre series of nonagenarians were identified [8][9][10][11][12][13][14][15][16][17][18][19] . Three reports [8,10,13] from a single institution covered overlapping time periods and could not be collated, so the largest series was chosen [10] .…”

Section: Literature Reviewmentioning

confidence: 99%

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Cardiac Surgery in Nonagenarians: Single-Centre Series and Review

Guilfoyle

Drain²,

Khan³

et al. 2009

Gerontology

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Background: Cardiac surgery is widely believed to be an excessively high-risk intervention for very elderly patients with coronary artery or valvular disease. However, as life expectancy and the prospect of sustained quality of life into older age increase, this assumption should be challenged so that surgery is not denied to patients who may derive significant symptomatic benefit with acceptable levels of operative risk. Objective: To evaluate outcomes from cardiac surgery in nonagenarian patients. Design: Analysis of prospectively collected single-centre data and review of outcomes reported in the literature. Results: Twenty-three patients (13 males) aged 90 years or more underwent open cardiac surgery between 1998 and 2007. Four patients died within 30 days of surgery (surgical mortality 17.4%) and all-cause in-hospital morbidity was 74%. Actuarial survival at 1 and 5 years was estimated at 72 and 54%, respectively. Comparison of patients’ survival against age-matched life tables for the English population found a standardised mortality ratio of 0.57 (95% CI: 0.24–0.99; one-sample log-rank test χ² = 3.93; p < 0.05) representing a significant survival benefit associated with surgery. The majority of patients reported symptomatic improvement reflected by significant decreases in angina and dyspnoea scores. Six single-centre series of nonagenarians and 3 reviews from national databases in the US and UK were identified in the literature. Pooled surgical mortality was 12.7% (95% CI: 8.7–17.3%) with no significant heterogeneity (χ² = 4.12; p = 0.77; I² = 0). Conclusion: Cardiac surgery in the elderly carries higher operative risk than in younger patients. However, in selected nonagenarians, surgery can be performed with acceptable morbidity and early mortality, and patients gain significant symptomatic relief and survival benefit.

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Cardiac Surgery in Nonagenarians

Abstract: Cardiac surgery in carefully selected nonagenarians is justified and can be performed with acceptable results.

Cited by 24 publications

References 46 publications

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians

Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years

Cardiac Surgery in Nonagenarians: Single-Centre Series and Review

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