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: 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.The Korean journal of thoracic and cardiovascular surgery. 10/2014; 47(5):451-7.
- Circulation 11/2013; 128(21):2333-43. · 14.95 Impact Factor
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ABSTRACT: PurposeHealth related quality of life (HRQoL)measured on the EuroQOL-5D -questionnaire have been shown to improve after coronary artery bypass grafting (CABG), the present study investigated whether changes in HRQoL predict later morbidity.Methods Included were 404 consecutive patients undergoing isolated CABG between 2008 and 2010 who filled the EQ-5D -questionnaire at baseline and 6 months postoperatively. Records were reviewed for later major adverse cardiac and cerebrovascular events (MACCE) after 6 months. Follow up was 38.6 months (10-58).ResultsPatients who suffered later MACCE more often had suffered an in-hospital postoperative stroke, had a longer in-hospital stay, had lower HRQoL scores at 6 months and deteriorated on several EQ-5D subscales. Logistic regression showed 6 months visual analogue scale scores and declining function -scores to be independent predictors of later MACCE.Conclusions Deteriorating function and HRQoL -scores at 6 months as compared to baseline postoperatively predict later adverse cardiovascular events after CABG.QJM: monthly journal of the Association of Physicians 12/2013; · 2.46 Impact Factor