Key result
Pulmonary endarterectomy in patients aged ≥70 years carried a comparable risk of in-hospital mortality to those <70 years (7.8% vs 4.6%; P=0.21), despite longer ICU and hospital stays.
Why the study?
Does pulmonary endarterectomy in patients aged ≥70 years have comparable outcomes to patients aged <70 years?
Cohort (n=411)
No
Does pulmonary endarterectomy in patients aged ≥70 years have comparable outcomes to patients aged <70 years?
Absolute Event Rate: 7.8% vs 4.6%
p-value: p=0.21
Pulmonary endarterectomy in patients aged ≥70 years is safe with comparable early mortality to younger patients, though it requires slightly longer ICU and hospital stays.
May support PEA in selected older patients; leaves open need for prospective data on long-term outcomes.
OBJECTIVES: Advanced age is not a barrier to cardiac surgery, with reports demonstrating excellent outcomes, but the effect of age on more complex surgery has not been studied. We assessed the outcomes of pulmonary endarterectomy (PEA) surgery in patients aged >70. METHODS: A retrospective review of consecutive patients who underwent PEA between January 2006 and March 2011 at a national referral centre. The total cohort was dichotomized according to age on the day of surgery, either below or above 70 years. Outcomes were in-hospital mortality, overall survival and the length of ICU and hospital stays. RESULTS: Four hundred and eleven patients underwent PEA during the 5-year period. The mean age was 56.9 years (range, 17-84 years). The in-hospital mortality was 14 of 308 (4.6%) for patients <70 years compared with 8 of 103 (7.8%) for patients ≥70 years (P = 0.21). The overall survival at 1, 2 and 3 years was 91.4, 89.9 and 87.7% in the <70-year old group and 85.9, 84.1 and 84.1% in the >70-year old group (log-rank test, P = 0.07), respectively. The length of ICU and in-hospital stays was longer in the >70-year old group, by 1 and 2 days, respectively (P = 0.005 and 0.001). CONCLUSIONS: PEA surgery in patients ≥70 years is safe and carries a comparable risk of early mortality in younger patients, but there is an increase in resource use due to longer ICU and hospital stays. Advanced age should be taken into consideration when assessing suitability for PEA, but age per se should not be a contraindication to surgery.
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Berman et al. (2012) conducted a cohort in Pulmonary endarterectomy (n=411). Age ≥70 years vs. Age <70 years was evaluated on In-hospital mortality (p=0.21). Pulmonary endarterectomy in patients aged ≥70 years carried a comparable risk of in-hospital mortality to those <70 years (7.8% vs 4.6%; P=0.21), despite longer ICU and hospital stays.
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