Long-term survival and quality of life justify cardiac surgery in the very elderly patient.

BACKGROUND

Elderly patients are often discouraged from undergoing cardiac surgery procedures owing to the perception of high mortality and poor functional outcomes. This study evaluates long-term survival and quality of life after cardiac surgery in octogenarian and nonagenarian patients.

METHODS

We identified a 459 patient cohort greater than 80 years of age who underwent elective cardiac surgery at our institution from 1994 to 1999. Survival was assessed with Kaplan-Meier analysis and compared with an age-matched and sex-matched population cohort. Among survivors, quality of life was assessed 8 years postoperatively using the Medical Outcomes Study Short Form 12 Health Survey, version 2. Risk factors for mortality were identified with Cox regression.

RESULTS

Operative mortality was 4.1%. Actuarial postoperative 5-year and 10-year survival was 53% and 27%, respectively. When compared with age- and sex-matched general population data, relative survival (excluding operative deaths) was 90.4% at 5 years and 78.7% at 10 years. Risk factors for late mortality included age greater than 85, male sex, low body mass index, renal failure, and postoperative respiratory failure. Survivors' median quality of life mental health score was higher (55.2 versus 48.9; p<0.05) and physical health score was equivalent (39.3 versus 39.8; p=0.66) to the general elderly population.

CONCLUSIONS

Cardiac surgery in the very elderly patient can be performed with low operative mortality, excellent long-term survival, and postoperative quality of life exceeding that of the general elderly population.