Cardiac Surgery in the Elderly

  • Margarita T. Camacho
  • Konstadinos A. Plestis
  • Jeffrey P. Gold


As the elderly population steadily rises each year, so does the number of patients referred for cardiac surgical procedures. The U.S. Census Bureau predicted that at least 6.2% of the United States population would be more than 80 years of age by the year 2000.1 Recent statistical actuarial data demonstrate that an individual aged 80 can expect to live an additional 8.1 years.2 A formidable challenge facing cardiologists and cardiac surgeons is the appropriate treatment of the 40% of a growing elderly population that suffers from symptomatic cardiovascular disease.3 The morbidity and mortality associated with cardiac surgical procedures in the elderly has substantially decreased since the late 1980s,4 although it is still somewhat higher than that of younger counterparts less than 75 years of age.5,6 Reports of acceptable mortality rates and improved long-term quality of life justify cardiac operations in most symptomatic elderly patients. Only recently have large studies focused on risk analyses and outcomes in an effort to provide the clinician with as much evidence-based literature as possible to make the most appropriate decisions for many of these complex elderly patients.


Mitral Valve Coronary Artery Bypass Valve Replacement Aortic Valve Replacement Mitral Valve Replacement 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Specer G. US Bureau of the Census: Projections of the Population of the United States, by Age, Sex and Race: 1988 to 2080. Current Population Reports, Series P-25, No. 1018. Government Printing Office: Washington, DC, 1989.Google Scholar
  2. 2.
    National Center for Health Statistics. Vital Statistics of the United States, 1989. Vital Health Statistics, vol 2. Government Printing Office: Washington, DC, 1992:11.Google Scholar
  3. 3.
    National Center for Health Statistics. Current Estimates From the National Health Interview Survey, 1989. Vital and Health Statistics, Series 10. Government Printing Office: Washington, DC, 1990:No. 176.Google Scholar
  4. 4.
    Peterson ED, Jollis JG, Bebchuk JD, et al. Changes in mortality after myocardial revascularization in the elderly Ann Intern Med 1994;121:919–927.Google Scholar
  5. 5.
    Horvath KA, DiSesa VJ, Peigh PS, et al. Favorable results of coronary artery bypass grafting in patients older than 75 years. J Thorac Cardiovasc Surg 1990;99:92–96.PubMedGoogle Scholar
  6. 6.
    Salomon NW, Page US, Bigelow JC, et al. Coronary artery bypass grafting in elderly patients: comparative results in consecutive series of 469 patients older than 75 years. J Thorac Cardiovasc Surg 1991;101:209–218.PubMedGoogle Scholar
  7. 7.
    Alexander KP, Peterson ED. Coronary artery bypass grafting in the elderly. Am Heart J 1997;134:856–864.PubMedCrossRefGoogle Scholar
  8. 8.
    Kern LS. The elderly heart surgery patient. Crit Care Nurs Clin North Am 1991;3:749–756.PubMedGoogle Scholar
  9. 9.
    Mezey MD, Rauckhorst LH, Stokes SA. Health Assessment of the Older Individual, 2nd ed. Springer: New York, 1993.Google Scholar
  10. 10.
    Smith Rossi M. The octogenarian cardiac surgery patient. J Cardiovasc Nurs 1995;9(4):75–95.Google Scholar
  11. 11.
    Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.PubMedCrossRefGoogle Scholar
  12. 12.
    Cane ME, Chen C, Bailey BM, et al. CABG in octogenarians: early and late events and actuarial survival in comparison with a matched population. Ann Thorac Surg 1995;60: 1033–1037.PubMedCrossRefGoogle Scholar
  13. 13.
    Williams DB, Carrillo RG, Traad EA, et al. Determinants of operative mortality in octogenarians undergoing coronary bypass. Ann Thorac Surg 1995;60:1038–1043.PubMedCrossRefGoogle Scholar
  14. 14.
    Akins CW, Daggett WM, Vlahakes GJ, et al. Cardiac operations in patients 80 years old and older. Ann Thorac Surg 1997;64:606–615.PubMedCrossRefGoogle Scholar
  15. 15.
    Iskandrian AS, Segal BL. Should cardiac surgery be performed in octogenarians? J Am Coll Cardiol 1991;18:36–37.PubMedCrossRefGoogle Scholar
  16. 16.
    Shirani J, Yousefì J, Roberts WC. Major cardiac findings at necropsy in 366 American octogenarians. Am J Cardiol 1995;75:151–156.PubMedCrossRefGoogle Scholar
  17. 17.
    Iskandrian AS, Hakki AH. The effects of aging after coronary artery bypass grafting on the regulation of cardiac output during upright exercise. Int J Cardiol 1985;7:347–360.PubMedCrossRefGoogle Scholar
  18. 18.
    Hakki AH, DePace NL, Iskandrian AS. Effect of age on left ventricular function during exercise in patients with coronary artery disease. J Am Coll Cardiol 11983:645–651.CrossRefGoogle Scholar
  19. 19.
    Iskandrian AS, Hakki AH. Age-related changes in left ventricular diastolic performance. Am Heart J 1986;112:75–78.PubMedCrossRefGoogle Scholar
  20. 20.
    Roberts WC. Ninety three hearts >90 years of age. Am J Cardiol 1993;71:599–602.PubMedCrossRefGoogle Scholar
  21. 21.
    Waller BF, Roberts WC. Cardiovascular disease in the very elderly: analysis of 40 necropsy patients aged 90 years or older. Am J Cardiol 1983;51:403–421.PubMedCrossRefGoogle Scholar
  22. 22.
    Roberts WC. The aging heart. Mayo Clin Proc 1988;63: 205–206.PubMedCrossRefGoogle Scholar
  23. 23.
    Gersh BJ, Kronmal RA, Schaff HV, et al. Long-term (5 year) results of coronary bypass surgery in patients 65 years or older: a report from the Coronary Artery Surgery Study. Circulation 1983;66(suppl II):190–199.Google Scholar
  24. 24.
    Naunheim KS, Kern MJ, McBride LR, et al. Coronary artery bypass surgery in patients aged 80 years or older. Am J Cardiol 1987;59:804–807.PubMedCrossRefGoogle Scholar
  25. 25.
    Morris RJ, Strong MD, Grunewald KE, et al. Internal thoracic artery for coronary artery grafting in octogenarians. Ann Thorac Surg 1996;62:16–22.PubMedCrossRefGoogle Scholar
  26. 26.
    Glower DD, Christopher TD, Milano CA, et al. Performance status and outcome after coronary artery bypass grafting in persons aged 80 to 93 years. Am J Cardiol 1992;70:567–571.PubMedCrossRefGoogle Scholar
  27. 27.
    Tsai T, Chaux A, Matloff JM, et al. Ten-year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg 1994;58:445–451.PubMedCrossRefGoogle Scholar
  28. 28.
    Ko W, Krieger KH, Lazenby WD, et al. Isolated coronary artery bypass grafting in one hundred consecutive octogenarian patients. J Thorac Cardiovasc Surg 1991;102:532–538.PubMedGoogle Scholar
  29. 29.
    Diegeler A, Autschbach R, Falk V, et al. Open heart surgery in the octogenarians: a study on long-term survival and quality of life. Thorac Cardiovasc Surg 1995;43:265–270.PubMedCrossRefGoogle Scholar
  30. 30.
    McGrath LB, Adkins MS, Chen C, et al. Actuarial survival and other events following valve surgery in octogenarians: comparison with age-, sex-, and race-matched population. Eur J Cardiothorac Surg 1991;5:319–325.PubMedCrossRefGoogle Scholar
  31. 31.
    Freeman WK, Schaff HV, O’Brien PC, et al. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol 1991;18:29–35.PubMedCrossRefGoogle Scholar
  32. 32.
    Bashour TT, Hanna ES, Myler RK, et al. Cardiac surgery in patients over the age of 80 years. Clin Cardiol 1990;13: 267–270.PubMedCrossRefGoogle Scholar
  33. 33.
    Naunheim KS, Dean PA, Fiore AC, et al. Cardiac surgery in the octogenarian. Eur J Cardiothorac Surg 1990;4:130–135.PubMedCrossRefGoogle Scholar
  34. 34.
    Deiwick M, Tandler R, Mollhoff TH, et al. Heart surgery in patients aged eight years and above: determinants of morbidity and mortality. Thorac Cardiovasc Surg 1997;45: 119–126.PubMedCrossRefGoogle Scholar
  35. 35.
    Wareing TH, Davila-Roman VG, Barzilai B, et al. Management of the severely atherosclerotic ascending aorta during cardiac operations. J Thorac Cardiovasc Surg 1992;103: 453–462.PubMedGoogle Scholar
  36. 36.
    Cannon LA, Marshall JM. Cardiac disease in the elderly population. Clin Geriatr Med 1993;9:499–525.PubMedGoogle Scholar
  37. 37.
    Davis EA, Gardner TJ, Gillinov AM, et al. Valvular disease in the elderly: influence on surgical results. Ann Thorac Surg 1993;55:333–338.PubMedCrossRefGoogle Scholar
  38. 38.
    Gehlot A, Mullany CJ, Ilstrup D, et al. Aortic valve replacement in patients aged eighty years and older: early and long-term results. J Thorac Cardiovasc Surg 1996;111: 1026–1036.PubMedCrossRefGoogle Scholar
  39. 39.
    Sahar G, Raanani E, Sagie A, et al. Surgical results in cardiac patients over the age of 80 years. Isr J Med Sci 1996;32: 1322–1325.PubMedGoogle Scholar
  40. 40.
    Logeais Y, Roussin R, Langanay T, et al. Aortic valve replacement for aortic stenosis in 200 consecutive octogenarians. J Heart Valve Dis 1995;4(suppl 1):S64-S71.PubMedGoogle Scholar
  41. 41.
    Klima U, Wimmer-Greinecker G, Mair R, et al. The octogenarians: a new challenge in cardiac surgery? Thorac Cardiovasc Surg 1994;42:212–217.PubMedCrossRefGoogle Scholar
  42. 42.
    Yashar JJ, Yashar AG, Torres D, Hittner K. Favorable results of coronary artery bypass and/or valve replacement in octogenarians. Cardiovasc Surg 1993;1:68–71.PubMedGoogle Scholar
  43. 43.
    Tsai T, Nessim S, Kass RM, et al. Morbidity and mortality after coronary artery bypass in octogenarians. Ann Thorac Surg 1991;51:983–986.PubMedCrossRefGoogle Scholar
  44. 44.
    Mullany CJ, Darling GE, Pluth JR, et al. Early and late results after isolated coronary artery bypass surgery in 159 patients aged 80 years and older. Circulation 1990;82 (suppl IV):229–236.Google Scholar
  45. 45.
    Kowalchuk GJ, Siu SC, McAuliffe LS, et al. Coronary artery bypass in octogenarians: early and late results. J Am Coll Cardiol 1990;15:35A.Google Scholar
  46. 46.
    Fiore AC, Naunheim KS, Barner HB, et al. Valve replacement in the octogenarian. Ann Thorac Surg 1989;48:104–108.PubMedCrossRefGoogle Scholar
  47. 47.
    Rich MW, Sandza JG, Kleiger RE, et al. Cardiac operations in patients over 80 years of age. J Thorac Cardiovasc Surg 1985;90:56–60.PubMedGoogle Scholar
  48. 48.
    Tsai TP, Matloff JM, Gray RJ, et al. Cardiac surgery in the octogenarian. J Thorac Cardiovasc Surg 1986;91:924–928.PubMedGoogle Scholar
  49. 49.
    Peterson ED, Cowper PA, Jollis JG, et al. Outcomes of coronary artery bypass graft surgery in 24,461 patients aged 80 years or older. Circulation 1995;92(suppl II):85–91.CrossRefGoogle Scholar
  50. 50.
    Curtis JJ, Walls JT, Boley TM, et al. Coronary revascularization in the elderly: determinants of operative mortality. Ann Thorac Surg 1994;58:1069–1072.PubMedCrossRefGoogle Scholar
  51. 51.
    Tuman KJ, McCarthy RJ, Najafi H, et al. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg 1992;104: 1510–1517.PubMedGoogle Scholar
  52. 52.
    Lee EM, Porter JN, Shapiro LM, et al. Mitral valve surgery in the elderly. Heart Valve Dis 1997;6:22–31.Google Scholar
  53. 53.
    Culliford AT, Galloway AC, Colvin SB, et al. Aortic valve replacement for aortic stenosis in persons aged 80 years and over. Am J Cardiol 1991;67:1256–1260.PubMedCrossRefGoogle Scholar
  54. 54.
    Kumar P, Zehr KJ, Cameron DE, et al. Quality of life in octogenarians after open heart surgery. Chest 1995;108:919–926.PubMedCrossRefGoogle Scholar
  55. 55.
    Remington M, Tyrer PJ, Newson-Smith J, et al. Comparative reliability of categorical and analogue rating scales in the assessment of psychiatric symptomatology. Psychol Med 1979;9:765–770.PubMedCrossRefGoogle Scholar
  56. 56.
    Campbell A, Converse PE, Ridgers WL. The Quality of American Life. Russell Sage: New York, 1976:1–583.Google Scholar
  57. 57.
    Bradburn NM. The structure of psychological well-being. Aldine: Chicago, 1969:214–215.Google Scholar
  58. 58.
    Adkins M, Amalfitano D, Harnum NA, et al. Efficacy of combined coronary revascularization and valve procedures in octogenarians. Chest 1995;108:927–931.PubMedCrossRefGoogle Scholar
  59. 59.
    Merrill WH, Steward JR, Frist WH, et al. Cardiac surgery in patients age 80 years or older. Ann Surg 1990;211:772–776.PubMedCrossRefGoogle Scholar
  60. 60.
    Edmunds LH, Stephenson LW, Edie RN, et al. Open-heart surgery in octogenarians. N Engl J Med 1988;319:131–136.PubMedCrossRefGoogle Scholar
  61. 61.
    Berens ES, Kouchoukos NT, Murphy SF, et al. Preoperative carotid artery screening in elderly patients undergoing cardiac surgery. J Vasc Surg 1992;15:313–323.PubMedCrossRefGoogle Scholar
  62. 62.
    Wareing TH, Davila-Roman VG, Barzilai B, et al. Management of the severely atherosclerotic ascending aorta during cardiac operations: a strategy for detection and treatment. J Thorac Cardiovasc Surg 1992;103:453–462.PubMedGoogle Scholar
  63. 63.
    Grawlee GP, Cordell AR, Graham JE, et al. Coronary revascularization in patients with bilateral internal carotid occlusion. J Thorac Cardiovasc Surg 1985;90:921–925.Google Scholar
  64. 64.
    Brener BJ, Bried DK, Alpert J, et al. The risk of stroke in patients with asymptomatic carotid stenosis undergoing cardiac surgery: a follow-up study. J Vasc Surg 1987;5: 269–279.PubMedGoogle Scholar
  65. 65.
    Sisto DA, Hoffman DM, Fernandes S, Frater RWM. Is use of the intraaortic balloon pump in octogenarians justified? Ann Thorac Surg 1992;54:507–511.PubMedCrossRefGoogle Scholar
  66. 66.
    He GW, Acuff TE, Ryan WH, et al. Determinants of operative mortality in elderly patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 1994;108: 73–81.PubMedGoogle Scholar
  67. 67.
    Ennabli K, Pelletier LC. Morbidity and mortality of coronary artery surgery after the age of 70 years. Ann Thorac Surg 1986;42:197–200.PubMedCrossRefGoogle Scholar
  68. 68.
    Higgins TL, Estafanous FG, Loop FD, et al. Stratification of morbidity and mortality outcome by pre-operative risk factors in coronary artery bypass patients: a clinical severity score. JAMA 1992;267:2344–2348.PubMedCrossRefGoogle Scholar
  69. 69.
    Utley JR, Leyland SA. Coronary artery bypass grafting in the octogenarian. J Thorac Cardiovasc Surg 1991;101:866–870.PubMedGoogle Scholar
  70. 70.
    Weintraub WS. Coronary operations in octogenarians: can we select the patients? Ann Thorac Surg 1995;60:875–876.PubMedCrossRefGoogle Scholar
  71. 71.
    Braunstein EM, Bajwa TK, Andrei L, et al. Early and late outcome of revascularization for unstable angina in octogenarians. J Am Coll Cardiol 1991;17:2:151A.CrossRefGoogle Scholar
  72. 72.
    Ko W, Gold JP, Lazzaro R, et al. Survival analysis of octogenarian patients with coronary artery disease managed by elective coronary artery bypass surgery versus conventional medical treatment. Circulation 1992;86(suppl II):191–197.Google Scholar
  73. 73.
    Mick MJ, Simpfendorfer C, Arnold AZ, et al. Early and late results of coronary angioplasty and bypass in octogenarians. Am J Cardiol 1991;68:1316–1320.PubMedCrossRefGoogle Scholar
  74. 74.
    Dancy M, Dawkins, Ward D. Balloon dilatation of the aortic valve; limited success and early restenosis. Br Heart J 1989;60:236–239.CrossRefGoogle Scholar
  75. 75.
    Litvack F, Jakubowski AT, Buchbinder NA, et al. Lack of sustained clinical improvement in an elderly population after percutaneous aortic valvuloplasty. Am J Cardiol 1988;62:270–275.PubMedCrossRefGoogle Scholar
  76. 76.
    Palacios I, Block PC, Brandi S, et al. Percutaneous balloon valvotomy for patients with severe mitral stenosis. Circulation 1987;75:778–786.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Margarita T. Camacho
  • Konstadinos A. Plestis
  • Jeffrey P. Gold

There are no affiliations available

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