Cirugía cardíaca en octogenarios: situación actual y perspectivas de futuro

Mortality and complications in elderly patients undergoing cardiac surgery

PURPOSE

The purpose of the study was to analyze postoperative complications, mortality, and related factors of elderly patients undergoing cardiac surgery.

METHODS

An observational, retrospective, and multicenter study of cardiac surgery patients, obtained from the ARIAM registry, was performed between 2008 and 2011. Clinical-surgical data, postoperative complications, and mortality were analyzed in a group of patients older than 75 years and in a younger group.

RESULTS

A total of 4548 patients were analyzed, with 882 (19.4%) patients at least 75 years old. Elderly patients had worse functional status (New York heart Association class) and comorbidities. The complication rate was higher in the elderly group (40.4% and 33.5%, respectively; P = .0001). Mortality in the elderly was 1.1%, 12%, and 15.1% (during surgery, intensive care unit [ICU], and 30-day mortality, respectively). Thirty-day mortality in elderly patients was higher when adjusted for EuroSCORE (European System for Cardiac Operative Risk Evaluation) and cardiopulmonary bypass time. The interaction between multiorgan dysfunction syndrome (MODS) and age more than 75 years was assessed by logistic regression, obtaining an odds ratio of 9.27 (5.88-14.60) for younger patients and 29.44 (12.22-70.94) for elderly patients who died during the ICU stay.

CONCLUSIONS

Age more than 75 years is an independent risk factor for ICU mortality when adjusted for EuroSCORE and cardiopulmonary bypass time. Elderly patients also have a higher rate of complications during ICU stay. Elderly patients develop MODS more frequently and present a higher mortality rate than younger patients with MODS.

Cirugía cardíaca en el anciano: nuevas perspectivas para una población en crecimiento

Improvement in socioeconomic and sanitary conditions during last 2 decades has lead to 4 year-life expectancy increasing in Spanish population. Increasing in age-related cardiovascular pathologies makes more necessary cardiac surgery in the elderly. Analysis of current characteristics of elderly population, cardiac surgery indications in this group, as well as morbimortality published results and future expectations, constitute the topic of this review.