Nonagenarians undergoing cardiac surgery

Background As life expectancy continues to rise and cardiac surgical outcomes improve, the number of nonagenarian (age > 90 years) patients undergoing cardiac operations is increasing. However, little has been reported on cardiac surgical outcomes in this select patient population. The purpose of this study was to examine current cardiac surgical outcomes for nonagenarian patients and determine the impact of extreme age on contemporary risk calculations. Study Design From 2002 to 20012, 61,303 patients underwent cardiac operations as reported in a statewide Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database, including 108 nonagenarians. Patient and operative factors, including STS Predicted Risk of Mortality (PROM), were analyzed in order to compare to estimated risk measures.

Results Nonagenarian patients (median age = 92 years) had a high prevalence of preoperative cerebrovascular disease (23.1% [25/108]) and arrhythmia (55.6% [60/108]). Isolated coronary artery bypass grafting (CABG) (39.8% [43/108]) was the most common operation performed within this cohort, followed by aortic valve replacement (AVR: 35.2% [38/108], AVR + CABG 23.1% [25/108]) operations. Overall nonagenarian mortality was 13% [14/108] and was greatest for AVR. Among nonagenarians with calculated STS PROM, observed to expected (O:E) ratios for mortality ranged from 1.45 to 2.65 annually over the study period.

Conclusions Nonagenarian patients represent a high-risk, elderly patient population with higher morbidity than predicted. Mortality is greatest following aortic valve operations. These results suggest that current risk calculations may underestimate the impact of extreme age on perioperative mortality.