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. 2013 Aug;17(2):340-3; discussion 343.
doi: 10.1093/icvts/ivt125. Epub 2013 Apr 28.

Cardiac surgery in nonagenarians: not only feasible, but also reasonable?

Alexander Assmann  1 , Jan-Philipp Minol, Arash Mehdiani, Payam Akhyari, Udo Boeken, Artur Lichtenberg
Affiliations

Cardiac surgery in nonagenarians: not only feasible, but also reasonable?

Alexander Assmann et al. Interact Cardiovasc Thorac Surg. 2013 Aug.

Abstract

Objectives: Changes in the age profile of the population in the western world and improvement in surgical techniques and postoperative care have contributed to a growing number of cardiosurgical patients aged over 90. In periods when transapical and transfemoral aortic valve replacement were done, we aimed at evaluating the outcome of nonagenarians after conventional aortic valve replacement and cardiac surgery in general, and determining perioperative parameters to predict a complicated postoperative course.

Methods: Between 1995 and 2011, 49 nonagenarians (aged 91.2±3.1 years) underwent cardiac surgery. A subgroup of 30 patients received aortic valve replacement alone (63%; n=19), in combination with coronary artery bypass grafting (27%; n=8) or other surgical procedures (10%; n=3). Most of the patients suffered from combined aortic valve disease with a mean valve orifice area of 0.6±0.3 cm2 and a mean antegrade pressure gradient of 86±22 mmHg.

Results: Cardiac surgery in nonagenarians resulted in remarkable postoperative morbidity and an overall in-hospital mortality of 10% (n=5). In the AVR subgroup, biological valve prostheses were implanted in 29 patients. In this subgroup, the length of stay was 2.9±0.9 days in the intensive care unit and 17.0±5.5 days in the hospital. The in-hospital mortality amounted to 13% (n=4). Although several general preoperative risk factors of postoperative complications such as renal failure, low cardiac output syndrome and New York Heart Association Class IV were remarkably more frequent among the patients who died after the operation, the small cohort of non-surviving nonagenarians did not allow for significant differences.

Conclusions: Cardiac surgery in the very elderly, particularly with regard to aortic valve replacement, carries a high risk of early morbidity and mortality. However, in selected nonagenarians, surgery can be performed with an acceptable outcome. The risk may even be reduced by an individual approach to the procedure. With regard to potential risk factors, the selection of these patients should be carried out very carefully.

Keywords: Aortic valve replacement; Cardiac surgery; Nonagenarians; Operative mortality; Outcome.

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Figures

Figure 1:
Figure 1:
After cardiac surgery (group TOTAL), and AVR in particular (group AVR), nonagenarians showed the displayed complication rates. CV: cardiovascular; PULM: pulmonary; NEUR: neurological; GI: gastrointestinal.
Figure 2:
Figure 2:
After cardiac surgery (group TOTAL), and AVR in particular (group AVR), nonagenarians showed the displayed ventilation (VENT), ICU stay (ICU) and hospital stay (HOSP) periods. Referring to the second y-axis, the broken line separates the corresponding bars.
Figure 3:
Figure 3:
In-hospital mortality of nonagenarians after cardiac surgery (group TOTAL), and AVR in particular (group AVR). Broken lines display the range of mortality for cardiac surgery in nonagenarians, as reported in the literature [2].
See this image and copyright information in PMC

Comment in

References

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