Abstract 2267: 20 Years Of Cardiac Surgery In Patients Aged 80 Years And Older - No Differences In Long Term Survival In 1003 Patients Compared To General Population
Patients aged 80 years and older are an increasing population and usually present with considerable comorbidity. For the indication to surgery long term survival and quality of life is decisive. We performed a retrospective analysis of 1003 patients aged 82.3 years (median, range 80–94.3 years) who underwent cardiac surgery between 1987–2006. Preoperative data, operative outcome and long term survival (mean follow up 42±34 months, range 0–172 months) were analysed. To evaluate the quality of life the short form 36 health status questionnaire was used. During last 20 years 303 patients underwent aortic valve replacement (AVR), 403 coronary artery bypass grafting (CABG) and 297 aortic valve replacement with coronary artery bypass grafting (AVR+CABG). Thirty day mortality was 10.1% for AVR+CABG, 7.9% for AVR and 7.4% for CABG. Mean survival time was 5.6±0.4 years for AVR+CABG, 6.4±0.3 years for AVR and 6.5±0.3 years for CABG. Actuarial survival at 1, 5 and 10 years was significantly lower in patients who underwent AVR+CABG (76.4±2.6%, 52.8±3.6% and 18.6±4.9%) compared to AVR (84.1±2.2%, 64±3.5% and 21.1±5%; p=0,021) and CABG (83±1.9%, 61.6±2.9% and 27.9±4.2%; p=0,018). However, comparing the actuarial survival of the 3 groups with a sex and age adjusted general population no significant differences were found. Furthermore, long term outcome was independent from sex and time of operation during last 20 years. Long term survival showed no improvement for the use of the internal thoracic artery (ITA) (84.1±2.2%, 63.7±3.6% and 29.4±7.8%. vs. 78.6±4.2%, 53.5±5.3% and 21.2±5%; p=0.17) compared to vein grafts. Overall incidence for dialysis was 8.3%, for prolonged ventilation 11.2%, for postoperative use of intraaortic balloon pump 3.8%, for cerebrovascular accident 2.2% and for a new episode of atrial fibrillation 25.3%. Length of stay was 10 days (median, range 0–157 days). Despite an increased incidence for postoperative complications and operative mortality in patients aged 80 years and older no differences in long term survival compared to an undiseased population were found. Patients who underwent AVR+CABG have a lower long term survival compared to AVR or CABG. Use of ITA showed no advantages for coronary revascularisation in patients aged 80 years and older.