Open heart operations in the elderly: changing risk parameters.

Abstract

Greater numbers of people are living longer, causing a concurrent change in the population of patients who require open heart operations. One question that needs to be addressed is the effect of age on surgical outcome. Current statistics suggest that in 15 to 20 years there will be 12 million people in the United States more than 80 years of age. We examined risk factors for outcome in two retrospective studies of advanced-age patients requiring cardiac operations. The first group of 100 patients more than 75 years of age had valve replacement. Early mortality was acceptable at 3%. However, mortality at 2 years increased to about 25%, due largely to complications related to anticoagulation. Quality of life was dramatically improved in survivors. These data suggest that implantation of a tissue valve may be the most beneficial option in patients aged more than 70 years. In the second group, we used multivariate analysis to define the factors contributing to early mortality in 133 patients aged 80 years or older who required cardiac operations from 1988 to 1990. This analysis showed that early mortality increased significantly in patients in New York Heart Association class IV or in those who required postoperative blood transfusion. These data suggest the need to prevent excessive bleeding and to assess patients on an individual basis.