Key result
Cardiac reoperation in octogenarians had a 32.1% in-hospital mortality, but survivors achieved a high level of independence and quality of life comparable to an age- and sex-matched population.
Why the study?
Do cardiac reoperations provide survival, functional, and quality of life benefits in octogenarians?
Cohort (n=84)
No
Do cardiac reoperations provide survival, functional, and quality of life benefits in octogenarians?
Despite high perioperative mortality, octogenarians who survive cardiac reoperations achieve a sustainable recovery with high independence and satisfactory quality of life, suggesting advanced age alone should not contraindicate redo surgery.
Answers are grounded in this paper and cite their sources.
High mortality after octogenarian cardiac reoperations warrants caution in selection; leaves open net benefit of redo surgery pending prospective trials.
AIM: According to the demographic development of our society, the numbers of octogenarians referred to cardiac surgery are continuously growing. Although the benefit of first-time cardiac procedures for these patients is well documented, the fate of octogenarians after redo-procedures, with special regard to long-term survival, functional status and quality of life, is poorly investigated. METHODS: We retrospectively identified 84 consecutive patients aged ≥80 years, who underwent a cardiac reoperation at the department for Cardiothoracic Surgery in the Heart & Vessel Center Bad Bevensen between January 2007 and 2013. Demographic profiles as well as operative data were analyzed, and the patients were prospectively followed. Patient's functional status and quality of life were assessed with the Barthel Index, New York Heart Association class and the short form-12 questionnaire. RESULTS: The mean age of the study group (61 men, 23 women) was 81.9 ± 1.9 years. Most redo-procedures were carried out after primary coronary artery bypass grafting (65%), primary aortic valve replacement (21%) and primary mitral valve replacement (6%). The most frequent actual surgical procedures were combined coronary artery bypass grafting and aortic valve replacement (26%), isolated coronary artery bypass grafting (19%), and isolated aortic valve replacement (19%). The mean length of hospital stay was 17 ± 15 days. In-hospital mortality counted for 32.1%. During follow up (29 ± 20 months) a further 19.0% of the patients died. The Barthel Index of the survivors was 89 ± 17 and their mean New York Heart Association class was 2 ± 1. A total of 93% of the patients were living at home. Summary scores of physical and mental health of the short form-12 questionnaire equalled those of an age- and sex-matched normative population. CONCLUSIONS: Despite high perioperative mortality, results document a sustainable recovery of the survivors offering the prospect of a highly independent and satisfying life. Therefore, advanced age alone should not be a contraindication for redo cardiac interventions. Geriatr Gerontol Int 2016; 16: 1138-1144.
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Deschka et al. (2015) conducted a cohort in Cardiac reoperation (n=84). Cardiac reoperation was evaluated on In-hospital mortality. Cardiac reoperation in octogenarians had a 32.1% in-hospital mortality, but survivors achieved a high level of independence and quality of life comparable to an age- and sex-matched population.
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