Abstract
Between October 1987 and July 1990, of 763 patients undergoing open heart surgery, 43 (5.6%) were 80 (mean and median 82) years of age or older. There were 20 men and 23 women. Eighteen patients (42%) were initially assessed using the angina score of the New York Heart Association or Canadian Cardiovascular Association as class IV. Nine procedures (21%) were performed electively and 34 (79%) urgently. A total of 26 patients (60%) underwent coronary bypass surgery, while 11 (26%) had valve replacements and six (14%) had both coronary bypass surgery and valve replacement; 74% of the patients received two or more grafts. The hospital mortality rate of the octogenarian patients was 9% (four of 43), significantly higher (P< 0.05) than the overall hospital mortality rate of 3.6% for patients ? 79 years of age. A history of myocardial infarction within 2 weeks before the procedure was obtained in nine of 43 patients (21%); 22 (51%) had experienced at least one myocardial infarction before surgery. Ejection fractions were ‘normal’ in 28 patients (65%), ‘fair’ in nine (21%) and ‘poor’ in six (14%). The mean length of hospital stay for the octogenarian patients was 19 (range 8–64) days. Thirty-five of the 39 operative survivors were followed for a mean of 14 (range 3–35) months. The actuarial probability of survival was 86% at the end of this time. A total of 31 patients (79%) assessed using the angina score of the New York Heart Association or Canadian Cardiovascular Association were class I or II. During the follow-up period, it was necessary to rehospitalize six patients, four because of cardiac problems; 27 of the 36 surviving patients (75%) had no cardiac symptoms. For those whose symptoms recurred, the mean time from operation to recurrence was 11 months.
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