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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2007 Dicembre;48(6):757-60
Cardiac surgery in nonagenarians
Hovanesyan A. 1, Moon M. R. 2, Rich M. W. 1,3
1 Department of Internal Medicine Washington University School of Medicine Barnes-Jewish Hospital St. Louis, MO, USA
2 Division of Cardiothoracic Surgery Washington University School of Medicine Barnes-Jewish Hospital St. Louis, MO, USA
3 Cardiovascular Division Washington University School of Medicine Barnes-Jewish Hospital St. Louis, MO, USA
Aim. To evaluate outcomes following cardiac surgery in nonagenarians.
Methods. A retrospective analysis of patients ≥90 years of age undergoing cardiac surgery at Barnes-Jewish Hospital from 1996-2006 was performed. The Social Security Death Index was used to determine late survival.
Results. Twenty-two subjects were identified. The mean age was 91 years (range 90-94) and 64% were women. The most common comorbidities included hypertension in 91% and heart failure (HF) in 65%. Mean New York Heart Association class was 3.5, mean left ventricular ejection fraction was 50% (range 27-80%), and mean creatinine clearance was 34±11 cc/min. No patients had prior cardiac surgery. Nine patients underwent coronary bypass grafting only, 11 had valve replacement only, and 2 had both. Concurrent operations included 1 ventricular septal defect repair, 2 carotid endarterectomies, and 1 ascending aortic patch angioplasty. Two cases were urgent, 2 were emergent, and the remainder were elective. There was one intraoperative death (5%), during urgent mitral valve replacement. The most common postoperative complications included atrial fibrillation and need for vasopressors for >48 hrs. Mean length of intensive care and total hospital stay were 3.4±4.5 and 12.2±8.5 days, respectively. Independent predictors of increased hospital stay were higher serum creatinine (P=0.028) and the presence of HF (P=0.050). Survival to 30, 90 and 365 days were, respectively: 86%, 77%, and 64%. At study conclusion, 7 patients (32%) were alive at a mean follow-up of 4.1 years.
Conclusion. Despite higher morbidity and mortality, in carefully selected nonagenarians referred for cardiac surgery, short-term complication rates and long-term outcomes appear to be acceptable.