[Cardiac surgery in elderly patients]

Abstract

Objective: The morbimortality of elderly patients, (age 70 years or older), who underwent surgery for valvular and coronary artery disease in the last 17 years was analyzed.

Patients and method: A total of 1,305 patients (654 valvular, 531 coronary and 120 combined) operated from January 1985 to December 2000 were retrospectively studied. Mean age was 73.7 years. We analyzed the progression of the pathology, comorbidity, and results. A second retrospective analysis was made of patients who underwent surgery in the last three years (436 patients) to determine the relation between preoperative comorbidity and postoperative evolution.

Results: The mean hospital mortality was 16% (18% valvular, 11% coronary artery, and 23% combined). In the last three years this mortality was reduced to 11% (15.17, 6.26, and 16.18%, respectively) despite an increase in comorbidity. Comorbidity and complications increased with age (p < 0.05). Mean hospital stay was 15.5 days and the stay in intensive/semi-intensive care was 5 days. Independent risk factors of postoperative complications were creatinine levels > 2 mg/dl, combined surgery, and prior surgery. Predictors of death were prior surgery, valvular surgery, and combined surgery, with a clear tendency in the case of obesity. The presence of any complication in the postoperative period (renal or respiratory failure, infections, or myocardial infarction) was an independent predictor of mortality. Off-pump coronary surgery reduced mortality. In recent years, the mortality of patients operated without extracorporeal circulation has decreased from 5.71% to 4% for those who underwent extracorporeal circulation.

Conclusions: Nowadays, cardiac surgery in older patients accounts for more than 30% of our surgical activity. Mortality is being controlled although comorbidity is increasing. The difference with respect to younger people is due to comorbidity (creatinine > 2 mg/dl, combined surgery, and previous surgery) and the higher probability of complications (infections, renal, and respiratory complications), which worsens prognosis. We believe that off-pump coronary surgery helps to improve results.