Surgery using cardiopulmonary bypass in the elderly.

Abstract

Patients (89), 70-82 yr (mean 72.8 yr), who had procedures using cardiopulmonary bypass since 1955 were studied. Twenty-six patients had elective aortic valve replacement (AVR), with 2 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 1 hospital death (10%). Fourteen patients had mitral valve replacement (MVR), with 8 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 2 early deaths. Six patients had other procedures with 1 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 6 survived. There were 10 late deaths. The actuarial survival rates for 1, 2 and 5 yr for all patients were 69% (40 patients), 47% (20 patients) and 21% (7 patients), respectively. At recent follow-up (mean 20 mo.) 84% of the hospital survivors were symptomatically improved at least 1 NYHA Functional Class. CABG and/or AVR can be performed in elderly patients with a low hospital mortality and with symptomatic improvement. MVR in the elderly carries an unusually high mortality (7.3.times. greater than patients less than 70), and this risk must be weighed when considering MVR in these patients.