Document Detail


Cardiac operations in the elderly: who is at risk?
MedLine Citation:
PMID:  9875769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: With the growing number of elderly patients presenting for cardiac operations we analyzed their early survival data to determine whether any preoperative variables might be indicative of increased risk. METHODS: From 1990 to 1995, 436 consecutive patients who were 75 years old or older had either coronary artery bypass, valve replacement(s), or a combination of these. A total of 34 preoperative variables were assessed for their effect on hospital survival by using univariate and multivariable analysis. RESULTS: There were 266 men and 170 women, with 292 patients being 75 to 80 years old and 144 patients being older than 80 years. Coronary artery bypass was performed in 242 patients, valve replacement was performed in 93 patients, and a combination of these in 101 patients. The operation was considered elective in 202 patients, urgent in 209, and emergent in 25 patients of whom 21 were in cardiogenic shock. Overall there were 61 hospital deaths (13.9%). The most common cause of death, low cardiac output syndrome, occurred in 34 patients of whom 26 suffered a perioperative myocardial infarction. Stroke was the cause of death in eight and multiple organ failure accounted for nine deaths. In the univariate analysis, variables that influenced survival included heart failure (p = 0.004), pulmonary edema (p = 0.004), cardiomegaly (p = 0.02), elevated serum creatinine (p = 0.009), surgical priority (p = 0.002), and cardiogenic shock (p = 0.002). In the multivariable analysis there were three independent determinants of hospital survival: cardiomegaly (odds ratio, 1.8:1) serum creatinine level higher than 150 micromol/L (odds ratio, 5.5:1) and emergency procedure (odds ratio, 2.5:1). CONCLUSIONS: Although cardiac operations can be performed safely in many elderly patients, we identified several factors that might help both in case selection and in perioperative decisions.
Authors:
G S Maharajh; R G Masters; W J Keon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  66     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-03     Completed Date:  1999-02-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1670-3     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiac Output, Low / etiology
Cardiac Surgical Procedures* / mortality
Cardiomegaly / complications
Coronary Artery Bypass
Creatinine / blood
Emergencies
Female
Heart Failure / complications
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / etiology
Postoperative Complications
Pulmonary Edema / etiology
Risk Factors
Shock, Cardiogenic / complications
Surgical Procedures, Elective
Chemical
Reg. No./Substance:
60-27-5/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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