[Cardiac surgery in the elderly: perioperative care and operative strategies]

Abstract

Caused by the age-dependent prevalence of cardiac diseases, the number of cardiac surgical interventions to geriatric patients is increasing. High life quality and life expectancy can be reached by cardiac operations. The advantage of cardiac surgical interventions is the decade's long positive effect. Accordingly also elderly benefit from complete revascularisation and from aortic valve replacement with biological prosthesis, which rarely degenerate in old age. A weak point is the surgical trauma, which can be reduced by less-invasive methods, such as OPCAB with aortic non-touch-technique, resulting in less than 1 % stroke. The indications for heart operations will be based on age-independent evidence-based guidelines. The decision for surgery is influenced by the expectation of the risk. This is defined by the co-morbidities and to lesser extent by the age per se. The operation risk can be calculated by risk-scores and hospital-specific data. The patient's expectations from the operation and his ability to overcome the accompanying stress must be thoroughly assessed. The operation must take place electively and at the right time. A good nutritional status and preoperative optimization of the organ functions are decisive for the prognosis. The blood-sugar-level must be optimized; thyroid function, (hidden) infections, anaemia and depression must be excluded or treated. The required screening tests should have been done already by the family doctor. The elderly are postoperatively susceptible to complications; especially low cardiac output, renal failure, respiratory insufficiency and stroke. Subsequently they need more intensive care.