Surgery using cardiopulmonary bypass in the elderly.

Abstract

This study included 89 patients, 70-82 years (mean 72.8 years), who had procedures using cardiopulmonary bypass since 1955. Twenty-six patients had elective aortic valve replacement (AVR), with two hospital deaths. One patient who underwent emergency AVR for bacterial endocarditis died of septic shock. Ten patients had AVR and coronary artery bypass surgery (CABG), with one hospital death (10%). Fourteen patients had mitral valve replacement (MVR), with eight hospital deaths (57%). Two died of left ventricular rupture after leaving the operating room, and the remainder died of low cardiac output. Twenty-five patients had CABG with no early deaths. Seven patients had aneurysms of the thoracic aorta, with two early deaths. Six patients had other procedures with one death, making a total of 16 operative deaths in the 89 patients. Eighty-four of the patients (94%) were New York Heart Association (NYHA) Functional Class III or IV for congestive heart failure and/or angina, preoperatively. Of these, 12 were in extremis immediately before surgery, and six survived. There were 10 late deaths. The actuarial survival rates for one, two and five years for all patients were 69% (40 patients), 47% (20 patients) and 21% (seven patients), respectively. At recent follow-up (mean 20 months) 84% of the hospital survivors were symptomatically improved at least one NYHA Functional Class. We conclude that CABG and/or AVR can be performed in elderly patients with a low hospital mortality and with symptomatic improvement. However, MVR in the elderly carries an unusually high mortality (7.3 times greater than patients less than 70, in our experience), and this risk must be weighed when considering MVR in these patients.