Cardiac surgery in the octogenarian: Perioperative outcome and clinical follow-up

W. K. Freeman, Hartzell V Schaff, P. C. O'Brien, T. A. Orszulak, James M Naessens, A. J. Tajik

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

The perioperative and follow-up results of cardiac operations employing extracorporeal circulation and cold cardioplegic arrest were examined in 191 consecutive patients ≥80 years of age having surgery over a 5 year period (1982 to 1986). Most patients had severe preoperative symptoms with functional class III (39.8%) or IV (57.1%) limitation. The overall 30 day postoperative cardiac mortality rate was 15.7%. The total in-hospital mortality rate was 18.8%; the mean postoperative hospital stay was 16.4 ± 13.3 days. The perioperative mortality rate for elective operations was as follows: coronary artery bypass (5.6%), aortic valve replacement (9.6%), aortic valve replacement with coronary bypass (17.9%) and mitral valve surgery with or without coronary bypass (21.4%). Urgent operations were performed in 39 patients (20.4%) with a total perioperative mortality rate of 35.9%; urgent coronary artery bypass was performed in 26 patients (67%) with an in-hospital mortality rate of 23.1%. Clinical evidence of left ventricular failure, functional class IV symptoms, left ventricular ejection fraction <50%, mitral valve repair or replacement for severe mitral regurgitation and urgent operation were associated with an increased perioperative mortality rate. Follow-up study in all 155 patients surviving postoperative hospitalization at 22.6 ± 14.8 months showed significant improvement in symptom status in all surgical subgroups. There were 18 follow-up deaths (11.6%); 10 were noncardiac. The actuarial survival rate of the entire study group was significantly better than that in age- and gender-matched control subjects (p = 0.037). Elective cardiac surgery can be performed in selected octogenarians without a prohibitive mortality rate and with significant lessening of symptoms and possibly, overall improvement in longevity of patients surviving postoperative hospitalization.

Original languageEnglish (US)
Pages (from-to)29-35
Number of pages7
JournalJournal of the American College of Cardiology
Volume18
Issue number1
StatePublished - 1991

Fingerprint

Thoracic Surgery
Mortality
Hospital Mortality
Aortic Valve
Mitral Valve
Coronary Artery Bypass
Hospitalization
Extracorporeal Circulation
Mitral Valve Insufficiency
Stroke Volume
Length of Stay
Survival Rate

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Cardiac surgery in the octogenarian : Perioperative outcome and clinical follow-up. / Freeman, W. K.; Schaff, Hartzell V; O'Brien, P. C.; Orszulak, T. A.; Naessens, James M; Tajik, A. J.

In: Journal of the American College of Cardiology, Vol. 18, No. 1, 1991, p. 29-35.

Research output: Contribution to journalArticle

@article{6879868de44a4a07a605c0db62df6658,
title = "Cardiac surgery in the octogenarian: Perioperative outcome and clinical follow-up",
abstract = "The perioperative and follow-up results of cardiac operations employing extracorporeal circulation and cold cardioplegic arrest were examined in 191 consecutive patients ≥80 years of age having surgery over a 5 year period (1982 to 1986). Most patients had severe preoperative symptoms with functional class III (39.8{\%}) or IV (57.1{\%}) limitation. The overall 30 day postoperative cardiac mortality rate was 15.7{\%}. The total in-hospital mortality rate was 18.8{\%}; the mean postoperative hospital stay was 16.4 ± 13.3 days. The perioperative mortality rate for elective operations was as follows: coronary artery bypass (5.6{\%}), aortic valve replacement (9.6{\%}), aortic valve replacement with coronary bypass (17.9{\%}) and mitral valve surgery with or without coronary bypass (21.4{\%}). Urgent operations were performed in 39 patients (20.4{\%}) with a total perioperative mortality rate of 35.9{\%}; urgent coronary artery bypass was performed in 26 patients (67{\%}) with an in-hospital mortality rate of 23.1{\%}. Clinical evidence of left ventricular failure, functional class IV symptoms, left ventricular ejection fraction <50{\%}, mitral valve repair or replacement for severe mitral regurgitation and urgent operation were associated with an increased perioperative mortality rate. Follow-up study in all 155 patients surviving postoperative hospitalization at 22.6 ± 14.8 months showed significant improvement in symptom status in all surgical subgroups. There were 18 follow-up deaths (11.6{\%}); 10 were noncardiac. The actuarial survival rate of the entire study group was significantly better than that in age- and gender-matched control subjects (p = 0.037). Elective cardiac surgery can be performed in selected octogenarians without a prohibitive mortality rate and with significant lessening of symptoms and possibly, overall improvement in longevity of patients surviving postoperative hospitalization.",
author = "Freeman, {W. K.} and Schaff, {Hartzell V} and O'Brien, {P. C.} and Orszulak, {T. A.} and Naessens, {James M} and Tajik, {A. J.}",
year = "1991",
language = "English (US)",
volume = "18",
pages = "29--35",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "1",

}

TY - JOUR

T1 - Cardiac surgery in the octogenarian

T2 - Perioperative outcome and clinical follow-up

AU - Freeman, W. K.

AU - Schaff, Hartzell V

AU - O'Brien, P. C.

AU - Orszulak, T. A.

AU - Naessens, James M

AU - Tajik, A. J.

PY - 1991

Y1 - 1991

N2 - The perioperative and follow-up results of cardiac operations employing extracorporeal circulation and cold cardioplegic arrest were examined in 191 consecutive patients ≥80 years of age having surgery over a 5 year period (1982 to 1986). Most patients had severe preoperative symptoms with functional class III (39.8%) or IV (57.1%) limitation. The overall 30 day postoperative cardiac mortality rate was 15.7%. The total in-hospital mortality rate was 18.8%; the mean postoperative hospital stay was 16.4 ± 13.3 days. The perioperative mortality rate for elective operations was as follows: coronary artery bypass (5.6%), aortic valve replacement (9.6%), aortic valve replacement with coronary bypass (17.9%) and mitral valve surgery with or without coronary bypass (21.4%). Urgent operations were performed in 39 patients (20.4%) with a total perioperative mortality rate of 35.9%; urgent coronary artery bypass was performed in 26 patients (67%) with an in-hospital mortality rate of 23.1%. Clinical evidence of left ventricular failure, functional class IV symptoms, left ventricular ejection fraction <50%, mitral valve repair or replacement for severe mitral regurgitation and urgent operation were associated with an increased perioperative mortality rate. Follow-up study in all 155 patients surviving postoperative hospitalization at 22.6 ± 14.8 months showed significant improvement in symptom status in all surgical subgroups. There were 18 follow-up deaths (11.6%); 10 were noncardiac. The actuarial survival rate of the entire study group was significantly better than that in age- and gender-matched control subjects (p = 0.037). Elective cardiac surgery can be performed in selected octogenarians without a prohibitive mortality rate and with significant lessening of symptoms and possibly, overall improvement in longevity of patients surviving postoperative hospitalization.

AB - The perioperative and follow-up results of cardiac operations employing extracorporeal circulation and cold cardioplegic arrest were examined in 191 consecutive patients ≥80 years of age having surgery over a 5 year period (1982 to 1986). Most patients had severe preoperative symptoms with functional class III (39.8%) or IV (57.1%) limitation. The overall 30 day postoperative cardiac mortality rate was 15.7%. The total in-hospital mortality rate was 18.8%; the mean postoperative hospital stay was 16.4 ± 13.3 days. The perioperative mortality rate for elective operations was as follows: coronary artery bypass (5.6%), aortic valve replacement (9.6%), aortic valve replacement with coronary bypass (17.9%) and mitral valve surgery with or without coronary bypass (21.4%). Urgent operations were performed in 39 patients (20.4%) with a total perioperative mortality rate of 35.9%; urgent coronary artery bypass was performed in 26 patients (67%) with an in-hospital mortality rate of 23.1%. Clinical evidence of left ventricular failure, functional class IV symptoms, left ventricular ejection fraction <50%, mitral valve repair or replacement for severe mitral regurgitation and urgent operation were associated with an increased perioperative mortality rate. Follow-up study in all 155 patients surviving postoperative hospitalization at 22.6 ± 14.8 months showed significant improvement in symptom status in all surgical subgroups. There were 18 follow-up deaths (11.6%); 10 were noncardiac. The actuarial survival rate of the entire study group was significantly better than that in age- and gender-matched control subjects (p = 0.037). Elective cardiac surgery can be performed in selected octogenarians without a prohibitive mortality rate and with significant lessening of symptoms and possibly, overall improvement in longevity of patients surviving postoperative hospitalization.

UR - http://www.scopus.com/inward/record.url?scp=0025847961&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025847961&partnerID=8YFLogxK

M3 - Article

C2 - 1904893

AN - SCOPUS:0025847961

VL - 18

SP - 29

EP - 35

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 1

ER -