ORIGINAL ARTICLES  ANESTHESIOLOGY Free access

Minerva Anestesiologica 2004 October;70(10):717-26

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

Low perioperative mortality for cardiac surgery in octogenarians

Zangrillo A. ¹, Sparicio D. ¹, Crivellari M. ¹, Aletti G. ², Bove T. ¹, Mamo D. ¹, Bignami E. ¹, Marino G. ¹, Landoni G. ¹

¹ Department of Cardiovascular Anesthesia IRCCS San Raffaele Hospital “Vita-Salute” University, Milan, Italy 2 Department of Mathematics University of Milan, Milan, Italy

Aim. The num­ber of car­diac oper­a­tions in octo­ge­nar­ians is stead­i­ly increas­ing. A ­review of per­son­al 4 ­years’ expe­ri­ence is ­made in ­order to iden­ti­fy ­which var­i­ables are asso­ciat­ed to a ­poor prog­no­sis in ­this ­high ­risk pop­u­la­tion.
Methods. Perioperative var­i­ables and ­short-­term out­come of 109 con­sec­u­tive octo­ge­nar­ians ­were pros­pec­tive­ly col­lect­ed in a data­base. Data ­were ana­lysed ­with descrip­tive sta­tis­tics. Univariate and mul­ti­var­i­ate anal­y­ses ­were per­formed to iden­ti­fy pre­op­er­a­tive ­risk fac­tors for pro­longed mechan­i­cal ven­ti­la­tion and ICU ­stay.
Results. The 109 octo­ge­nar­ians rep­re­sent­ed 1.8% of the 4 940 car­diac oper­a­tions per­formed at our University Teaching Hospital in the peri­od January 1998 - June 2001: 94 ­patients had comor­bid­ities (86%); 46 under­went ­valve sur­gery (42%), 38 had cor­o­nary ­artery ­bypass graft­ing sur­gery (36%), and com­bined pro­ce­dures or aor­tic ­arch replace­ment ­were per­formed in 25 ­patients (22%). Two ­patients ­died (1.8%). Post­op­er­a­tive com­pli­ca­tions includ­ed: myo­car­dial infarc­tion (10 ­patients, 9%), ­stroke (6 ­patients, 5%), ­renal replace­ment ther­a­py (1 ­patient, 1%). Sixty ­nine ­patients (63%) had an unevent­ful per­i­op­er­a­tive peri­od (63%). On a mul­ti­var­i­ate anal­y­sis, car­di­o­pul­mo­nary ­bypass (CPB) ­time was asso­ciat­ed ­with pro­longed intu­ba­tion and ICU ­stay; ­mitral pathol­o­gy pre­dict­ed pro­longed intu­ba­tion ­while pre­vi­ous car­diac sur­gery was asso­ciat­ed ­with pro­longed ICU ­stay.
Conclusion. The 109 octo­ge­nar­ians stud­ied had an excel­lent ­course in the imme­di­ate post­op­er­a­tive peri­od. Therefore, on the ­basis of per­son­al expe­ri­ence car­diac sur­gery ­could be safe­ly per­formed in octo­ge­nar­ians