Outcomes of cardiac surgery in nonagenarians

A 10-year experience

Matthew D. Bacchetta, Wilson Ko, Leonard N. Girardi, Charles A. Mack, Karl H. Krieger, O. Wayne Isom, Leonard Lee

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background. With an increasing awareness of health issues and greater emphasis on preventive medicine, the general population is living longer and healthier lives than ever before. Physicians are taking care of older patients, many of whom may require cardiac surgical procedures. Improving cardiopulmonary bypass technology allows for safer procedures with reduced morbidity and mortality even in older patients. Methods. We have performed a retrospective analysis of 42 consecutive nonagenarian patients who underwent open-heart procedures over a 10-year period (1993 to 2002) at our institution. Their demographic profiles, operative data, perioperative results, and long-term outcomes were recorded and analyzed. Results. Twenty-two women and 20 men with an age range of 90 to 97 years (mean, 91.4 years) had open-heart surgery over the study period. The complication rate was 67% overall, consisting of 7% respiratory (pneumonia, respiratory failure, reintubation), 7% hemorrhagic or embolic (postoperative bleeding, cerebral vascular accident), 12% infectious (wound infection, sepsis), and 31% new arrhythmia (atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation). Despite these complication rates, average hospital stay was 17.5 days (median, 11 days), with an intensive care unit stay of 12.0 days (median, 5 days). Thirty-day survival was 95% and survival to discharge was 93% (three deaths total; one cardiac arrest at hospital day 134 and two perioperative deaths; one ventricular arrhythmia, one cerebral vascular accident). The only statistically significant risk factor of mortality was emergency surgery. Currently, 81% are still alive an average of 2.53 years since surgery (range, 0.16 to 7.1 years). Conclusions. With improving techniques and greater attention to detail, the select nonagenarian can safely undergo cardiac surgery.

Original languageEnglish (US)
Pages (from-to)1215-1220
Number of pages6
JournalAnnals of Thoracic Surgery
Volume75
Issue number4
DOIs
StatePublished - Apr 1 2003
Externally publishedYes

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antineoplaston A10
Thoracic Surgery
Accidents
Blood Vessels
Cardiac Arrhythmias
Cardiac Surgical Procedures
Atrial Flutter
Preventive Medicine
Survival
Mortality
Ventricular Fibrillation
Wound Infection
Ventricular Tachycardia
Heart Arrest
Cardiopulmonary Bypass
Respiratory Insufficiency
Intensive Care Units
Length of Stay
Sepsis
Pneumonia

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Bacchetta, M. D., Ko, W., Girardi, L. N., Mack, C. A., Krieger, K. H., Isom, O. W., & Lee, L. (2003). Outcomes of cardiac surgery in nonagenarians: A 10-year experience. Annals of Thoracic Surgery, 75(4), 1215-1220. https://doi.org/10.1016/S0003-4975(02)04666-0
Bacchetta, Matthew D. ; Ko, Wilson ; Girardi, Leonard N. ; Mack, Charles A. ; Krieger, Karl H. ; Isom, O. Wayne ; Lee, Leonard. / Outcomes of cardiac surgery in nonagenarians : A 10-year experience. In: Annals of Thoracic Surgery. 2003 ; Vol. 75, No. 4. pp. 1215-1220.
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Bacchetta, MD, Ko, W, Girardi, LN, Mack, CA, Krieger, KH, Isom, OW & Lee, L 2003, 'Outcomes of cardiac surgery in nonagenarians: A 10-year experience', Annals of Thoracic Surgery, vol. 75, no. 4, pp. 1215-1220. https://doi.org/10.1016/S0003-4975(02)04666-0

Outcomes of cardiac surgery in nonagenarians : A 10-year experience. / Bacchetta, Matthew D.; Ko, Wilson; Girardi, Leonard N.; Mack, Charles A.; Krieger, Karl H.; Isom, O. Wayne; Lee, Leonard.

In: Annals of Thoracic Surgery, Vol. 75, No. 4, 01.04.2003, p. 1215-1220.

Research output: Contribution to journalArticle

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AU - Bacchetta, Matthew D.

AU - Ko, Wilson

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AU - Krieger, Karl H.

AU - Isom, O. Wayne

AU - Lee, Leonard

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N2 - Background. With an increasing awareness of health issues and greater emphasis on preventive medicine, the general population is living longer and healthier lives than ever before. Physicians are taking care of older patients, many of whom may require cardiac surgical procedures. Improving cardiopulmonary bypass technology allows for safer procedures with reduced morbidity and mortality even in older patients. Methods. We have performed a retrospective analysis of 42 consecutive nonagenarian patients who underwent open-heart procedures over a 10-year period (1993 to 2002) at our institution. Their demographic profiles, operative data, perioperative results, and long-term outcomes were recorded and analyzed. Results. Twenty-two women and 20 men with an age range of 90 to 97 years (mean, 91.4 years) had open-heart surgery over the study period. The complication rate was 67% overall, consisting of 7% respiratory (pneumonia, respiratory failure, reintubation), 7% hemorrhagic or embolic (postoperative bleeding, cerebral vascular accident), 12% infectious (wound infection, sepsis), and 31% new arrhythmia (atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation). Despite these complication rates, average hospital stay was 17.5 days (median, 11 days), with an intensive care unit stay of 12.0 days (median, 5 days). Thirty-day survival was 95% and survival to discharge was 93% (three deaths total; one cardiac arrest at hospital day 134 and two perioperative deaths; one ventricular arrhythmia, one cerebral vascular accident). The only statistically significant risk factor of mortality was emergency surgery. Currently, 81% are still alive an average of 2.53 years since surgery (range, 0.16 to 7.1 years). Conclusions. With improving techniques and greater attention to detail, the select nonagenarian can safely undergo cardiac surgery.

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Bacchetta MD, Ko W, Girardi LN, Mack CA, Krieger KH, Isom OW et al. Outcomes of cardiac surgery in nonagenarians: A 10-year experience. Annals of Thoracic Surgery. 2003 Apr 1;75(4):1215-1220. https://doi.org/10.1016/S0003-4975(02)04666-0