CLINICAL STUDIES
Outcomes of cardiac surgery in patients age  80 years: results from the National Cardiovascular Network
Karen P. Alexander, MD*  ,
Kevin J. Anstrom, MS*,
Lawrence H. Muhlbaier, PhD*  ,
Ralph D. Grosswald, MPH||,
Peter K. Smith, MD, FACC ,
Robert H. Jones, MD, FACC and
Eric D. Peterson, MD, MPH, FACC*
* Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
|| National Healthcare Network, Atlanta, Georgia, USA
Manuscript received February 25, 1999;
revised manuscript received October 22, 1999,
accepted November 18, 1999.
Reprint requests and correspondence: Dr. Karen P. Alexander, Box 3411, Duke University Medical Center, Durham, North Carolina 27710
alexa019{at}mc.duke.edu
OBJECTIVES
The purpose of this study was to evaluate characteristics and outcomes of patients age  80 undergoing cardiac surgery.
BACKGROUND
Prior single-institution series have found high mortality rates in octogenarians after cardiac surgery. However, the major preoperative risk factors in this age group have not been identified. In addition, the additive risks in the elderly of valve replacement surgery at the time of bypass are unknown.
METHODS
We report in-hospital morbidity and mortality in 67,764 patients (4,743 octogenarians) undergoing cardiac surgery at 22 centers in the National Cardiovascular Network. We examine the predictors of in-hospital mortality in octogenarians compared with those predictors in younger patients.
RESULTS
Octogenarians undergoing cardiac surgery had fewer comorbid illnesses but higher disease severity and surgical urgency than younger patients. Octogenarians had significantly higher in-hospital mortality after cardiac surgery than younger patients: coronary artery bypass grafting (CABG) only (8.1% vs. 3.0%), CABG/aortic valve (10.1% vs. 7.9%), CABG/mitral valve (19.6% vs. 12.2%). In addition, they had twice the incidence of postoperative stroke and renal failure. The preoperative clinical factors predicting CABG mortality in the very elderly were quite similar to those for younger patients with age, emergency surgery and prior CABG being the powerful predictors of outcome in both age categories. Of note, elderly patients without significant comorbidity had in-hospital mortality rates of 4.2% after CABG, 7% after CABG with aortic valve replacement (CABG/AVR), and 18.2% after CABG with mitral valve replacement (CABG/MVR).
CONCLUSIONS
Risks for octogenarians undergoing cardiac surgery are less than previously reported, especially for CABG only or CABG/AVR. In selected octogenarians without significant comorbidity, mortality approaches that seen in younger patients.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass grafting | | CABG/AVR | = coronary artery bypass grafting with aortic valve replacement | | CABG/MVR | = coronary artery bypass grafting with mitral valve replacement or repair | | CHF | = congestive heart failure | | COPD | = chronic obstructive pulmonary disease | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction | | NCN | = National Cardiovascular Network | | NYHA | = New York Heart Association |
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