Cardiac Surgery in the Elderly: Comparison Between Medium-Term Clinical Outcomes in Octogenarians and the Elderly From 75 to 79 Years

Introduction and objectives. The age of patients undergoing cardiac surgery has increased in recent years. Our aims were to investigate the medium-term clinical outcomes of surgery in octogenarians and to compare them with outcomes in other elderly individuals of a less advanced age. Methods. We investigated early mortality, the incidence of postoperative complications, medium-term survival and factors associated with these parameters in 589 consecutive elderly patients undergoing surgery: 140 were octogenarians aged 80-87 years (group I) while 449 were aged between 75 and 79 years (group II). Results. The 2 groups were similar. There was no difference in mortality (10.0% in group I vs 10.9% in group II) or in the incidence of postoperative complications (22% in group I vs 30% in group II). Emergency surgery, combined surgery, and pulmonary hypertension were all independent predictors of mortality and of major postoperative complications. The 5-year survival rate was 79% in group I and 65% in group II (P=.832) and the cardiac event-free survival rate was 75% in group I and 64% in group II (P=.959). Overall, 97% of patients in both groups were in functional class I or II. The additive EuroSCORE and preoperative atrial fibrillation were both associated with increased mortality during follow-up. Being an octogenarian was not a predictor (hazard ratio=0.78; 95% confidence interval, 0.51-1.21; P=.373). Conclusions. In selected octogenarians, cardiac surgery gives similar results to those obtained in other elderly individuals of a less advanced age. The mediumterm survival rate and quality of life are good. Pulmonary hypertension, emergency surgery and combined surgery all increased risk in these patients.