Long-Term Survival and Quality of Life Justify Cardiac Surgery in the Very Elderly Patient
ABSTRACT Elderly patients are often discouraged from undergoing cardiac surgery procedures owing to the perception of high mortality and poor functional outcomes. This study evaluates long-term survival and quality of life after cardiac surgery in octogenarian and nonagenarian patients.
We identified a 459 patient cohort greater than 80 years of age who underwent elective cardiac surgery at our institution from 1994 to 1999. Survival was assessed with Kaplan-Meier analysis and compared with an age-matched and sex-matched population cohort. Among survivors, quality of life was assessed 8 years postoperatively using the Medical Outcomes Study Short Form 12 Health Survey, version 2. Risk factors for mortality were identified with Cox regression.
Operative mortality was 4.1%. Actuarial postoperative 5-year and 10-year survival was 53% and 27%, respectively. When compared with age- and sex-matched general population data, relative survival (excluding operative deaths) was 90.4% at 5 years and 78.7% at 10 years. Risk factors for late mortality included age greater than 85, male sex, low body mass index, renal failure, and postoperative respiratory failure. Survivors' median quality of life mental health score was higher (55.2 versus 48.9; p<0.05) and physical health score was equivalent (39.3 versus 39.8; p=0.66) to the general elderly population.
Cardiac surgery in the very elderly patient can be performed with low operative mortality, excellent long-term survival, and postoperative quality of life exceeding that of the general elderly population.
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ABSTRACT: Background The balance of the risks and the benefits of cardiac surgery in the elderly remains a major concern. We evaluated the early and mid-term clinical results of patients aged over 75 years who underwent major cardiovascular surgery. Methods Two hundred and fifty-one consecutive patients, who underwent cardiac surgery at Seoul National University Bundang Hospital between July 2003 and June 2011, were included in this study (mean age, 78.7±3.4 years; male:female=130:121). Elective surgery was performed in 112 patients, urgent in 90, and emergency in 49. Results Early mortality was 12.7% (32/251). Follow-up completion was 100%, and the mean follow-up duration was 2.8±2.2 years. Late mortality was 24.2% (53/219). There were 283 readmissions in a total of 109 patients after discharge. However, the reason for readmission was related more to non-cardiac factors (71.3%) than to cardiac factors. The overall survival estimates were 79.2% at the 1-year follow-up and 58.4% at the 5-year follow-up. Patients who underwent elective surgery had a lower early mortality rate (elective, 4.5%; urgent, 13.3%; emergency, 30.6%) and better overall survival rate than those that underwent urgent or emergency surgery (p <0.001). Conclusion The timing of cardiac surgery was found to be an independent risk factor for early and late mortality. Thus, earlier referral and intervention may improve operative results. Further, comprehensive coordinated postoperative care is needed for other comorbid problems in aged patients.10/2014; 47(5):451-7. DOI:10.5090/kjtcs.2014.47.5.451
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ABSTRACT: The idea of protecting the heart from ischemic insult during heart surgery to allow elective cardiac arrest is as old as the idea of cardiac surgery itself. The current gold standard in clinical routine is a high potassium regimen added either to crystalloid or blood cardioplegic solutions inducing depolarized arrest. Ongoing patient demographic changes with increasingly older, comorbidly ill patients and increasing case complexity with increasingly structurally abnormal hearts as morphological correlate paired with evolutions in pediatric cardiac surgery allowing more complex procedures than ever before redefine requirements for cardioprotection. Many, in part adversarial, regimens to protect the myocardium from ischemic insults have entered clinical routine; however, functional recovery of the heart is still often impaired due to perfusion injury. Myocardial reperfusion damage is a key determinant of postoperative organ functional recovery, morbidity, and mortality in adult and pediatric patients. There is a discrepancy between what current protective strategies are capable of and what they are expected to do in a rapidly changing cardiac surgery community. An increased understanding of the molecular players of ischemia reperfusion injury offers potential seeds for new cardioprotective regimens and may further displace boundaries of what is technically feasible.BioMed Research International 09/2014; 2014:325725. DOI:10.1155/2014/325725 · 2.71 Impact Factor
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ABSTRACT: Current outcome measures in cardiac surgery are largely described in terms of mortality. Given the changing demographic profiles and increasingly aged populations referred for cardiac surgery this may not be the most appropriate measure. Postoperative quality of life is an outcome of importance to all ages, but perhaps particularly so for those whose absolute life expectancy is limited by virtue of age. We undertook a systematic review of the literature to clarify and summarise the existing evidence regarding postoperative quality of life of older people following cardiac surgery. For the purpose of this review we defined our population as people aged 80 years of age or over. A systematic review of MEDLINE, EMBASE, Cochrane Library, trial registers and conference abstracts was undertaken to identify studies addressing quality of life following cardiac surgery in patients 80 or over. Forty-four studies were identified that addressed this topic, of these nine were prospective therefore overall conclusions are drawn from largely retrospective observational studies. No randomised controlled data were identified. Overall there appears to be an improvement in quality of life in the majority of elderly patients following cardiac surgery, however there was a minority in whom quality of life declined (8-19%). There is an urgent need to validate these data and if correct to develop a robust prediction tool to identify these patients before surgery. Such a tool could guide informed consent, policy development and resource allocation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.BMJ Open 04/2015; 5(4):e006904. DOI:10.1136/bmjopen-2014-006904 · 2.06 Impact Factor