OBJECTIVES: Changes in the age profile of the population in the western world and improvement in surgical techniques and postoperative care have contributed to a growing number of cardiosurgical patients aged over 90. In periods when transapical and transfemoral aortic valve replacement were done, we aimed at evaluating the outcome of nonagenarians after conventional aortic valve replacement and cardiac surgery in general, and determining perioperative parameters to predict a complicated postoperative course. METHODS: Between 1995 and 2011, 49 nonagenarians (aged 91.2±3.1 years) underwent cardiac surgery. A subgroup of 30 patients received aortic valve replacement alone (63%; n=19), in combination with coronary artery bypass grafting (27%; n=8) or other surgical procedures (10%; n=3). Most of the patients suffered from combined aortic valve disease with a mean valve orifice area of 0.6±0.3 cm2 and a mean antegrade pressure gradient of 86±22 mmHg. RESULTS: Cardiac surgery in nonagenarians resulted in remarkable postoperative morbidity and an overall in-hospital mortality of 10% (n=5). In the AVR subgroup, biological valve prostheses were implanted in 29 patients. In this subgroup, the length of stay was 2.9±0.9 days in the intensive care unit and 17.0±5.5 days in the hospital. The in-hospital mortality amounted to 13% (n=4). Although several general preoperative risk factors of postoperative complications such as renal failure, low cardiac output syndrome and New York Heart Association Class IV were remarkably more frequent among the patients who died after the operation, the small cohort of non-surviving nonagenarians did not allow for significant differences. CONCLUSIONS: Cardiac surgery in the very elderly, particularly with regard to aortic valve replacement, carries a high risk of early morbidity and mortality. However, in selected nonagenarians, surgery can be performed with an acceptable outcome. The risk may even be reduced by an individual approach to the procedure. With regard to potential risk factors, the selection of these patients should be carried out very carefully.
OBJECTIVES: Changes in the age profile of the population in the western world and improvement in surgical techniques and postoperative care have contributed to a growing number of cardiosurgical patients aged over 90. In periods when transapical and transfemoral aortic valve replacement were done, we aimed at evaluating the outcome of nonagenarians after conventional aortic valve replacement and cardiac surgery in general, and determining perioperative parameters to predict a complicated postoperative course. METHODS: Between 1995 and 2011, 49 nonagenarians (aged 91.2±3.1 years) underwent cardiac surgery. A subgroup of 30 patients received aortic valve replacement alone (63%; n=19), in combination with coronary artery bypass grafting (27%; n=8) or other surgical procedures (10%; n=3). Most of the patients suffered from combined aortic valve disease with a mean valve orifice area of 0.6±0.3 cm2 and a mean antegrade pressure gradient of 86±22 mmHg. RESULTS: Cardiac surgery in nonagenarians resulted in remarkable postoperative morbidity and an overall in-hospital mortality of 10% (n=5). In the AVR subgroup, biological valve prostheses were implanted in 29 patients. In this subgroup, the length of stay was 2.9±0.9 days in the intensive care unit and 17.0±5.5 days in the hospital. The in-hospital mortality amounted to 13% (n=4). Although several general preoperative risk factors of postoperative complications such as renal failure, low cardiac output syndrome and New York Heart Association Class IV were remarkably more frequent among the patients who died after the operation, the small cohort of non-surviving nonagenarians did not allow for significant differences. CONCLUSIONS: Cardiac surgery in the very elderly, particularly with regard to aortic valve replacement, carries a high risk of early morbidity and mortality. However, in selected nonagenarians, surgery can be performed with an acceptable outcome. The risk may even be reduced by an individual approach to the procedure. With regard to potential risk factors, the selection of these patients should be carried out very carefully.
Authors: J F Gummert; A K Funkat; A Beckmann; M Ernst; K Hekmat; F Beyersdorf; W Schiller Journal: Thorac Cardiovasc Surg Date: 2011-06-10 Impact factor: 1.827
Authors: Matthew D Bacchetta; Wilson Ko; Leonard N Girardi; Charles A Mack; Karl H Krieger; O Wayne Isom; Leonard Y Lee Journal: Ann Thorac Surg Date: 2003-04 Impact factor: 4.330
Authors: W Ko; K H Krieger; W D Lazenby; Y T Shin; M Goldstein; R Lazzaro; O W Isom Journal: J Thorac Cardiovasc Surg Date: 1991-10 Impact factor: 5.209
Authors: Sophie Piérard; Stéphanie Seldrum; Christophe de Meester; Agnès Pasquet; Bernhard Gerber; David Vancraeynest; Gébrine El Khoury; Philippe Noirhomme; Annie Robert; Jean-Louis Vanoverschelde Journal: Ann Thorac Surg Date: 2011-02-18 Impact factor: 4.330
Authors: Brant W Ullery; Janey C Peterson; Federico Milla; Martin T Wells; William Briggs; Leonard N Girardi; Wilson Ko; Anthony J Tortolani; O Wayne Isom; Karl H Krieger Journal: Ann Thorac Surg Date: 2008-03 Impact factor: 4.330
Authors: Mani Arsalan; Molly Szerlip; Sreekanth Vemulapalli; Elizabeth M Holper; Suzanne V Arnold; Zhuokai Li; Michael J DiMaio; John S Rumsfeld; David L Brown; Michael J Mack Journal: J Am Coll Cardiol Date: 2016-03-29 Impact factor: 24.094
Authors: Maria E Tecos; Brittany S Kern; Nathan A Foje; Marilyn L Leif; Mitchell Schmidt; Allie Steinberger; Adam Bajinting; Keely L Buesing Journal: Surg Open Sci Date: 2020-04-26
Authors: Sacha Bull; Margaret Loudon; Jane M Francis; Jubin Joseph; Stephen Gerry; Theodoros D Karamitsos; Bernard D Prendergast; Adrian P Banning; Stefan Neubauer; Saul G Myerson Journal: Eur Heart J Cardiovasc Imaging Date: 2015-03-21 Impact factor: 6.875