Updated review of the coronary artery bypass grafting option in octogenarians: good tidings

The evolution of cardiovascular surgery in elderly patient: a review of current options and outcomes

Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient.

Herzchirurgie im Alter

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing. We have reviewed the literature to analyse whether and how far octogenarians benefit from cardiac surgical procedures. Different studies analysed the outcome of patients in different age groups after cardiac surgery. Octogenarians can undergo cardiac surgical procedures at a reasonable risk. The perioperative mortality and other postoperative complications are strongly dependent on comorbidities rather than on patients' age. Elderly patients benefit from improved functional status and quality of life.

Left ventricular filling patterns and pulmonary artery pressures in patients aged 90 to 100 years with normal echocardiography results

Left ventricular filling and pulmonary artery pressure (PAP) have not been well described in patients > or = 90 years old. We reviewed our database to obtain echocardiograms with normal findings in this age group. The peak early and late mitral filling velocities, the early and late velocity-time integral (VTI), the mitral deceleration time, and the atrial filling fraction (late VTI/total VTI) were measured. PAP was obtained from the peak tricuspid regurgitation velocity. Of 252 echocardiograms performed on patients > or = 90 years old, 47 (19%) were normal. The mean +/- SD values were: ratio of peak early and late mitral filling velocities, 0.69 +/- 0.16; deceleration time, 240 milliseconds +/- 31; ratio of early and late VTI, 1.0 +/- 0.3; atrial filling fraction, 47% +/- 7; and PAP, 31 mm Hg +/- 6. Left ventricular filling in patients aged 90 to 100 years demonstrates increasingly impaired left ventricular relaxation from patients in their eighth and ninth decades. PAP continues to increase with age and PAP < or = 40 mm Hg in the elderly could be considered normal.