Cardiovascular Surgery in Patients 85 or Older

Shigeyoshi Gon	Yasuyuki Yamada	Ikuko Shibasaki
Toshiyuki Kuwata	Takayuki Hori	Go Tsuchiya
Masahiro Seki	Yuriko Kiriya	Takashi Kato and Hirotsugu Fukuda

（Dokkyo Medical University Hospital, Heart Center, Cardiac and Vascular Surgery, Tochigi, Japan）

Background:This study was performed to evaluate surgical outcomes after cardiovascular surgery（including urgent surgery）in patients 85 or older. Methods:A retrospective analysis was performed on 39 patients（mean age, 86.3 years;age range, 85-90 years）who underwent total arch replacement（n＝4), ascending aorta replacement（n＝4), descending aorta replacement（n＝1), aortic valve replacement（AVR;n＝13), mitral valve replacement or valvuloplasty（n＝3), coronary artery bypass grafting（CABG;n＝9), CABG＋AVR（n＝4), tumor resection（n＝1）between June 2008 and December 2012 at Dokkyo Medical University Hospital. Results:Six hospital deaths occurred. One patient died due to bleeding from a ruptured descending thoracic aortic aneurysm, and another patient died due to gastrointestinal perforation from non-occlusive mesenteric ischemia（NOMI）after urgent AVR. The other deaths were related to various complications, including lung cancer, cholecystitis, myocardial infarction, and Takotsubo cardiomyopathy, during the postoperative period. Overall 30-day mortality was 2.6%, hospital mortality was 12.8%, duration of hospital stay after surgery was 41.3 days, duration of intensive care unit（ICU）stay was 3.8 days and ventilator time was 49.1 h. Twenty patients underwent elective surgery, and 19 patients underwent urgent surgery. The two groups had similar preoperative characteristics, except for the number of patients with aortic disease. No significant difference was evident in hospital mortality（26.3% vs. 5%, p＝0.065）or 30-day mortality（0% vs. 5.3%, p＝0.3）when comparing the two groups. However, the duration of hospital stay（58.9 days vs. 27.5 days, p＝0.049), ICU stay（6.74 days vs. 1.05 days, p＝0.002）and ventilator time（89.9 h vs. 8.2 h, p＝0.006）was significantly longer in the urgent surgery group than in the elective surgery group. Fourteen patients（70%）in the elective surgery group and four patients（21.1%）in the urgent surgery group were able to be discharged from the hospital to their homes within 30 days after surgery. These data demonstrated that cardiovascular surgery in patients 85 years of age or older was associated with satisfactory outcomes, and outcomes associated with elective surgery were even better than those associated with urgent surgery. Conclusions:Therefore, advanced age does not represent a contraindication of conventional cardiovascular surgery. Rather, the decision for surgery should take the patient’s preoperative condition, the severity of concurrent medical disease, the wishes of the patient, and the predicted functional outcomes into account.

 

Jpn. J. Cardiovasc. Surg. 43:170-176（2014）

Keywords：85 years old;elderly patient;cardiovascular surgery