Risks and benefits of open-heart surgery in patients 70 years of age and older.

From January 1978 to December 1982, 165 consecutive patients aged 70 to 81 years underwent various open-heart surgical procedures at the St. Boniface General Hospital in Winnipeg. Preoperatively, most of the patients were in functional class III or IV (New York Heart Association classification). Overall operative mortality for the series was 10.9%. Isolated coronary artery bypass surgery, performed in 71 patients, had an operative mortality of 2.8%. Results were also good in isolated single and double valve replacement in 58 patients (operative mortality 8.6%); there were no deaths in a group of 27 patients who underwent isolated aortic valve replacement. Thirty-six patients with various combined, extensive procedures had the poorest result (operative mortality 30.5%). More than 90% of surviving patients were in functional class I or II postoperatively. The complication rate, although high, was acceptable. Immediate and long-term clinical improvement in the majority of patients justifies a surgical approach except in patients who require combined, extensive procedures.