Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy

Autor: M. L. Hillion, Daniel Loisance, Matthias Kirsch, Laurent Guesnier, M. Debauchez, Jacques R. Séguin, Paul LeBesnerais
Rok vydání: 1998
Předmět:
Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
Heart disease
medicine.medical_treatment
Hypertension
Pulmonary
Ventricular Function
Left
Ventricular Dysfunction
Left
Sex Factors
Aortic valve replacement
Actuarial Analysis
Risk Factors
Internal medicine
Cause of Death
Activities of Daily Living
medicine
Humans
Hospital Mortality
Risk factor
Coronary Artery Bypass
Aged
Retrospective Studies
Aged
80 and over
Heart Valve Prosthesis Implantation
Ejection fraction
business.industry
Mitral valve replacement
Stroke Volume
Perioperative
medicine.disease
Surgery
Survival Rate
medicine.anatomical_structure
Treatment Outcome
Patient Satisfaction
Aortic Valve
Multivariate Analysis
Cardiology
Quality of Life
Mitral Valve
Female
France
Cardiology and Cardiovascular Medicine
business
Complication
Artery
Follow-Up Studies
Zdroj: The Annals of thoracic surgery. 66(1)
ISSN: 0003-4975
Popis: With the progressive aging of western populations, cardiac surgeons are increasingly faced with elderly patients.We reviewed the records of 191 consecutive patients aged 80 years or older (mean age, 83 +/- 2.4 years) who underwent a cardiac surgical procedure at our institution from 1991 through 1996.Ninety-eight patients were men. Preoperatively, 32% of patients were in New York Heart Association class III or IV, and mean left ventricular ejection fraction was 0.55 +/- 0.02. One hundred ten patients (58%) underwent aortic valve replacement, 47 (25%) had coronary artery bypass grafting, 26 (14%) had combined aortic valve replacement and coronary artery bypass grafting, 5 (3%) underwent mitral valve replacement, and 3 (1.6%) had other procedures. Postoperative complications occurred in 69.1% of patients. The hospital mortality rate was 16.2%. Actuarial survival estimates at 1 year, 3 years, and 5 years were 79.2%, 74.9%, and 56.2%, respectively. Multivariate predictors (p0.05) of hospital death were preoperative pulmonary hypertension and lower left ventricular ejection fraction. Multivariate predictors of late death were combined aortic valve replacement and coronary artery bypass grafting and female sex. Sixty-four percent of long-term survivors were fully autonomous, and female sex was the only independent predictor of impaired autonomy. Eighty-three percent of survivors were satisfied with their present quality of life.Cardiac operations can be performed in octogenarians with a favorable long-term outcome. Earlier referral and intervention is mandatory to improve results in this patient population.
Databáze: OpenAIRE
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