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Efficacy of combined coronary revascularization and valve procedures in octogenarians.
- Source :
-
Chest [Chest] 1995 Oct; Vol. 108 (4), pp. 927-31. - Publication Year :
- 1995
-
Abstract
- From January 1982 to October 1991, 42 consecutive patients 80 years of age and older underwent a combined cardiac procedure with coronary revascularization and valve repair or replacement. There were 20 women and 22 men. Mean age at operation was 82.8 years (range, 80 to 89.7 years). Twenty-seven patients (64%) were in New York Heart Association (NYHA) functional class III or IV preoperatively. Six patients (14.3%) had undergone previous cardiac procedures. There were six hospital deaths (14.3%). The only significant preoperative risk factor identified for the event hospital death was aortic insufficiency (p = 0.005). The 36 hospital survivors were followed up at a mean of 21.1 months after hospital discharge. There were nine (21%) late deaths occurring at a mean of 21.3 months postoperatively: two from acute myocardial infarctions and seven from chronic heart failure. Survival analysis indicated that higher preoperative NYHA class (p = 0.0003), hypertension (p = 0.015), hypercholesterolemia (p = 0.03), and elevated left atrial/left ventricular gradient (p = 0.04) were incremental risk factors for overall mortality. The actuarial survival at 40 months was 51.9%, with no significant difference as compared with an age-, sex-, and race-matched population. Of the 27 late survivors, 26 were in NYHA class I or II. We conclude that octogenarians may undergo complex cardiac surgical procedures with an expectation of an acceptable mortality rate and significant improvement in their functional status. These results must be taken into consideration in light of reported strategies to ameliorate health-care costs by limiting availability of complex medical care to the elderly.
- Subjects :
- Aged
Aged, 80 and over
Combined Modality Therapy
Female
Follow-Up Studies
Hospital Mortality
Humans
Male
Postoperative Complications epidemiology
Postoperative Complications surgery
Reoperation statistics & numerical data
Risk Factors
Survival Rate
Time Factors
Aortic Valve surgery
Bioprosthesis mortality
Bioprosthesis statistics & numerical data
Catheterization mortality
Catheterization statistics & numerical data
Coronary Artery Bypass mortality
Coronary Artery Bypass statistics & numerical data
Heart Valve Prosthesis mortality
Heart Valve Prosthesis statistics & numerical data
Mitral Valve surgery
Subjects
Details
- Language :
- English
- ISSN :
- 0012-3692
- Volume :
- 108
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 7555162
- Full Text :
- https://doi.org/10.1378/chest.108.4.927