ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Open heart surgery and results in patient population aged 80 years and older
Mehmet Erdem Toker, İlker Mataracı, Ahmet Çalışkan, Ercan Eren, Hasan Basri Erdoğan, Rahmi Zeybek, Mehmet Balkanay, Cevat Yakut
Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniği, İstanbul
Background: The aim of this study was to evaluate the results of open heart surgery operations in patients aged 80 and over.

Methods: The study includes 103 patients (60 males, 43 females; mean age 81.3±2.4 years; range 80 to 93 years) who underwent open heart surgery in our clinic between January 2000 and May 2007. Fourty seven patients (45.6%) underwent on-pump coronary artery bypass grafting (CABG), 25 (24.3%) were off pump coronary artery bypass (OPCAB), 11 (10.7%) were aortic valve replacement (AVR), six (5.8%) were CABG + AVR, four (3.9%) were CABG + Mitral valve replacement (MVR), three (2.9%) were CABG + Mitral reconstruction, two (1.9%) were AVR + MVR, two were (1.9%) CABG + Carotis endarterectomy, one (0.9%) was MVR, one (0.9%) was AVR + Mitral reconstruction, and one (0.9%) was mitral reconstruction.

Results: Early mortality was 23.3% with 24 patients. The incidence of low cardiac output syndrome (LCOS) was 28.2% (29 patients). Perioperative myocardial infarction occured in eight patients (7.8%), mediastinitis occured in six patients (5.8%). Postoperative cerebrovascular problems developed in five patients (4.9%). Revision due to bleeding is applied in three patients (2.9%). Permanent pacemaker is implanted in three patients (2.9%). Intraaortic balloon pump was inserted in 14 (13.6%) patients. Univariant determinants were longer aortic cross clamp time (p=0.004), preoperative NYHA class III and IV (p=0.007), chronic obstructive pulmonary disease (COPD, p=0.049), valvular surgery (isolated valve or valvular and coronary intervention, p=0.019). Multivariant determinants affecting the mortality were patients’ being in NYHA class III or IV (p=0.009) preoperatively, left ventricular ejection fraction lower than 50%, and valvular surgery (isolated valve or valvular and coronary intervention, p=0.009).

Conclusion: Open heart surgery in patients at the age of 80 and over can be performed with high mortality and acceptable morbidity. In the presence of comorbid diseases, lower mortality can be achieved with the determination of the surgical technique to be performed.

Keywords : Aged; coronary artery bypass graft; eighty and over; left ventricular dysfunction
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