Cardiac Surgery in Octogenarians: Early Outcome and Medium-Term Survival

Abstract

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.