Contemporary perioperative results of cardiac surgery in the elderly- our experience

Abstract

Objective With progressive aging of population in developing nations, cardiac surgeons increasingly face elderly patients. These patients are usually symptomatic, yet at high risk for intervention. This study aims to review our experience in elderly Indian patients. Methods We reviewed the records of 128 elderly patients (mean age 74.6 years; range 70-84) operated at our institution from 2005 to 2009. Postoperatively, patients were followed-up in the out-patient-department. Results Surgery was performed on 10 as an emergency and 41 on an urgent (on the day of referral or the following day) basis. Mean left ventricular ejection fraction was 44%± 9.5. Early mortality (during current admission or within 30 days of discharge from the hospital) was 12 (9.3%). Mean New York Heart Association functional class was improved from 3.0±0.8 preoperatively to 1.5±0.7 postoperatively. Median Intensive Care Unit and in-hospital stay was 4 days (range 1-17) and 12 days (range 4-37), respectively. Postoperative complications included pneumonia (6.3%), stroke (5.5%), reoperation for bleeding (4.6%) and intra-aortic balloon pump requirement (4.6%). Emergency surgery was significantly associated (P<0.05) with an increased risk of early mortality-operative procedure and cardiopulmonary bypass time were not. Conclusion We conclude that cardiac surgery can be performed in elderly population with an acceptable early mortality. Postoperatively, patients attain an improved quality of life. Operative procedures and cardiopulmonary bypass times are not risk factors for increased mortality. Emergency surgery in this group of patients is less rewarding.

Características clínico-demográficas de pacientes submetidos a cirurgia de revascularização do miocárdio e sua relação com a mortalidade

“…In this study, this older population represented more than 40% of the sample, which may partially explain the high mortality rate observed. The mortality rate related to CABG and observed in studies restricted to the elderly population tends to be higher (9.3% to 16.3%) [8][9][10]. In studies of more heterogeneous populations, the mean age of the non-survivors is usually significantly higher [3,[11][12][13][14].…”

“…Treatment of elderly patients is challenging, considering the high risk for surgery caused by their lower physiological reserves, the increased prevalence of comorbidities and a higher likelihood of symptoms. These conditions can result in urgent or emergency surgery, another factor that influences the rate of mortality [6][7][8][9].…”