Outcomes of cardiac surgery in nonagenarians

Background: While advanced age can be considered by some a contraindication to open-heart surgery, there is a paucity of data regarding outcomes of cardiac surgery in nonagenarians. We, therefore, sought to investigate the outcomes of nonagenarians undergoing cardiac surgery. Methods: A retrospective review of our institutional Society of Thoracic Surgeons database between 1993 and 2019 was performed. Among a total of 32,421 patients who underwent open-heart surgery, 134 patients (0.4%) were nonagenarians (50.7% females, median age 91.6 [interquartile range: 90.7–92.9]). A comparison was performed between nonagenarians and patients aged 80–89 years. A regression analysis was performed to evaluate factors associated with midterm mortality in nonagenarians. Results: The incidence of cardiac surgery in nonagenarians has been stable over time, from 0.4% in (1993–2000), 0.5% in (2001–2010) to 0.4% in (2011–2019). Valve surgery and CABG+valve were higher in nonagenarians compared to octogenarians (44.8% vs. 25.6%, 39.6% vs. 30.7%, respectively), but CABG was lower (15.7% vs. 33.8%); p <.01. Urgent/emergent surgery status was similar between groups (p =.7). Operative mortality was similar in the two groups (6% vs. 4.6%, p =.5). Hospital complications were comparable between groups. Conclusion: Cardiac surgery in nonagenarians can be achieved with acceptable morbidity and mortality. This study can be a benchmark for risk stratification for cardiac surgery in this high-risk population.