Original article: cardiovascular
Predictors of postoperative complications in high-risk octogenarians undergoing cardiac operations

https://doi.org/10.1016/S0003-4975(02)03741-4Get rights and content

Abstract

Background. Cardiac operations in octogenarians are currently reserved for selected patients with severe symptoms and low extracardiac comorbidity; early and midterm results are satisfactory. We evaluated the outcome of high-risk octogenarians undergoing cardiac operations and investigated the predictors of postoperative complications.

Methods. Between June 1998 and March 2001, 73 consecutive octogenarians (mean age = 83.1 ± 3.0 years) hospitalized and awaiting operation in our Department were analyzed for postoperative complications. We recorded the main risk factors for cardiovascular disease, symptoms of heart failure, previous myocardial infarction, reoperation, left ventricular ejection fraction, use of intraaortic balloon pump, surgical priority, and operative risk. Cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and renal failure were the preoperative extracardiac comorbidities considered. We adopted a multidisciplinary approach to perioperative management.

Results. Surgical procedures included coronary artery bypass grafting in 36 patients (49.3%), valve procedures in 20 (27.4%), and combined coronary artery bypass grafting and valve procedures in 17 patients (23.3%). In-hospital death occurred in 6 patients (8.2%). Twenty-one patients (28.8%) had major postoperative complications including renal failure (15.1%), respiratory failure (8.2%), and myocardial infarction (8.2%). The main predictors of postoperative complications were New York Heart Association functional class IV, Canadian Cardiovascular Society angina class 4, and prolonged aortic cross-clamping time.

Conclusions. Cardiac operations can achieve satisfactory results even in high-risk octogenarians. Early surgical intervention before severe symptoms appear, and a multidisciplinary approach to perioperative management, may reduce postoperative complications.

Section snippets

Study patients

Between June 1998 and March 2001 (34 months), 73 consecutive octogenarians operated on at our Department of Cardiac Surgery were prospectively analyzed for postoperative complications. There were 32 women (43.8%) and 41 men, ranging in age from 80 to 89 years, with a mean of 83.1 ± 3.0 years and a median of 82 years.

Arterial hypertension, diabetes mellitus, obesity, and history of cigarette smoking were the most prevalent risk factors for cardiovascular disease. Symptoms of heart failure were

Results

Preoperatively, 29 patients (39.7%) were in NYHA functional class IV, and 32 (60.4%, 32 of 53) of those who had isolated or combined CABG were in CCS angina class 4. Operations were performed with urgent or emergent surgical priority in 39 patients (53.4%). All patients had European SCORE 6 or plus and 24 (32.9%) had OPR SCORE 8 or plus.

Surgical procedures included CABG in 36 patients (49.3%), valve repair or replacement in 20 (27.4%), and combined CABG and valve procedures in 17 patients

Comment

Many original articles published in the past decade show that cardiac operation in the severely symptomatic octogenarian selected on the basis of low extracardiac comorbidity can be performed with an acceptable mortality (6% to 16%), but that postoperative complications occur often (20% to 68% of patients) including transient or permanent neurologic dysfunction (10% to 14%), respiratory failure (4% to 23%), MI (0% to 5%), renal failure (2% to 13%), reoperation due to bleeding (2% to 15%),

Acknowledgements

We sincerely thank Dr Larry Bonchek for his valuable contribution to the language-editing of this manuscript.

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