CARDIAC SURGERY IN OCTOGENERIANS -TIHE GREEN LANE EXPERIENCE 1995-1998.
S.P. Wong*, S.R. Dixon, P.R. Ruygrok, M.E. Legge.
Department of Cardiology, Green Lane, Hospital, Auckland, New Zealand.
An increasing number of patients aged over 30 years are being considered and accepted for cardiac surgery. Between January 1995 and September 1998, 37 octogenarians underwent such operations at Green Lane Hospital. The mean age was 82.8 ± 1.4 years (range 80.4 to 86.2 ) and 23 (62%) were male. All were fully independent pre-operatively. Pre-operative symptoms were severe in most patients. Co-existing morbidity was minor.
All patients were listed for urgent surgery, with two proceeding to have emergency operations. The operations were isolated coronary revascularisation in 20 (54%), aortic valve replacement alone in 6 (16%), and both procedures in 11 (30%). There were four early deaths (11%) and 5 peri-operative neurological events - one fatal and one causing major disability. The mean duration of post-operative intensive care admission was 2.7±3.9 days (range 0.05 to 16, median 1.0) and of post-operative hospital stay 14.0±13.9 days (range 0 to 79, median 11. Twenty-four of the 33 survivors were able to be discharged to their own dwelling, with three discharged to the care of relatives, three to residential care and three requiring transfer to a rehabilitation ward.
The mean duration of follow-up has been 20.0 months (range 1.5 to 41.8) There have been two late deaths, both non-cardiac. In 97% of survivors the NYHA Class was I or II. Twenty-six (84%) of the 31 survivors were living in their own home, one (3%) with relatives, and four (13%) were in residential care. Twenty-three (74%) of the 26 at home were fully independent. Survey responses were received from all 33 hospital survivors and their general practitioners, with all giving the opinion that cardiac surgery had been beneficial.
Conclusion: In this population of sick elderly patients early mortality from cardiac surgery is higher than for the general population undergoing similar operations but is acceptable, as is post-operative resource use. The intermediate term outcome and quality of life for survivors is good.
