Age Should Not Rule Out Cardiac Surgery in Octogenarians: Presented at ESC

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Title: Age Should Not Rule Out Cardiac Surgery in Octogenarians: Presented at ESC
URL: http://www.pslgroup.com/dg/22A7FA.htm
Doctor's Guide
September 3, 2008

By Chris Berrie

MUNICH, Germany -- September 3, 2008 -- Primary cardiac surgery and cardiac reoperation in patients 80 years or older result in a similar mortality, long-term survival, and quality of life as it does in younger patients, according to a retrospective study presented here at the European Society of Cardiology 2008 Congress (ESC).

It is known that patients 80 years and older can benefit from open-heart surgery. However, in Germany, almost 50% of patients undergoing open-heart surgery currently are older than 70 years, with a mean time between primary cardiac surgery and reoperation of 8 to 12 years, according to Markus Krane, MD, German Heart Centre, Department of Cardiovascular Surgery, Technische Universität München, Munich, Germany.

"We expect that cardiac surgery in octogenarians will be an increasing population in the future, so we performed this study to use our experience [with reoperation] over the last 10 years to see if the outcome is appropriate in this population," said Dr. Krane in a moderated poster session on September 1.

To determine the survival benefits of reoperative cardiac surgery for octogenarians, Dr. Krane and colleagues compared 71 patients with a mean age of 83 years who underwent reoperative cardiac surgery and 71 patients with a mean age of 83 years who underwent primary cardiac operations.

Patients were matched for age, gender, year of operation, and surgical procedure, and there were no significant differences seen between the groups in baseline clinical characteristics.

Assessments were made according to patient demographic profile, operative data, long-term survival, and quality of life (Short Form 36 Health Survey questionnaire [SF-36]). In the reoperation group, the average time since the previous operation was 10.8 years.

In the surgical procedures, significant differences were seen between the reoperation and primary cardiac surgery groups for average operating time (282.5 vs 198.5 minutes; P = .001) and cardiopulmonary bypass time (118.3 vs 103.7 minutes; P = .045). No significant difference was seen for aortic cross-clamp time (75.0 vs 72.4 minutes).

Similarly, no significant differences were seen for median length of intensive care unit stay (4 days for each group) or median length of hospital stay (11 vs 10 days).

Mortality rates at 30 days were not significantly different between the groups, at 14.7% in the reoperation group and 8.5% in the primary cardiac surgery group (P = .43). This was also the case for the SF-36 physical health summarised score (40.7 vs 39.1; P = .55) and mental health summarised score (51.9 vs 48.0; P = .24).

Octogenarians therefore showed similar mortality, long-term survival, and quality of life following primary and reoperation cardiac surgery, indicating, Dr. Krane said, that, "cardiac reoperation surgical procedures should not be reserved for younger patients alone."

[Presentation title: Is Reoperative Cardiac Surgery in Octogenarians Justified? Abstract P1884]

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