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Cardiac Valve Surgery in Octogenarians
Improving Quality of Life and Functional Status
Junaid H. Khan, MD;
Doff B. McElhinney, MD;
Tim S. Hall, MD;
Scot H. Merrick, MD
Arch Surg. 1998;133:887-893.
Background Although cardiac valve procedures are being performed more frequently in the elderly, long-term functional outcomes have not been well characterized.
Objective To evaluate changes in quality of life and functional status in octogenarians after cardiac valve surgery.
Design Retrospective medical record review and patient telephone interview. Median follow-up 30 months (range, 6-95 months).
Setting Tertiary care university hospital.
Patients Octogenarians undergoing cardiac valve surgery (N=61; mean age, 83.5 years; range, 80-89 years).
Interventions Forty-seven patients had aortic valve replacement, 14 had mitral valve replacement and/or repair, and 27 had a combined procedure with coronary artery bypass grafting.
Outcomes Actuarial survival, morbidity, length of hospital stay, and discharge disposition were evaluated. Functional status, using the New York Heart Association classification, and Karnofsky performance status were evaluated preoperatively and postoperatively at 1 and 3 months after hospital discharge.
Results Operative (<30 days) mortality occurred in 7 (11.4%) of 61 patients. Preoperative intensive care unit stay (P<.001) and New York Heart Association class 4 (P<.02) were independent predictors of early death by multivariable analysis. Among hospital survivors, there were no major complications in 34 patients (63%), and this group had a mean (±SD) postoperative hospital stay of 12.2±5.5 days. Twenty patients (37%) incurred significant complications, the most common of which were bleeding, pneumonia, and renal insufficiency. The mean (±SD) postoperative hospital stay in this group was 25±17 days. Although significant complications were associated with an increased postoperative stay, this was not predictive of disposition to a skilled nursing facility or the final score on the postoperative Karnofsky performance scale. Actuarial survival was 85% at 1 year and 66% at 5 years. Patients with perioperative complications had significantly decreased actuarial survival by the Cox proportional hazards regression model (P<.001). Among hospital survivors, the score on the Karnofsky performance scale 1 month after discharge had improved 50% from a preoperative median score of 30% (severely disabled, requiring special care) to a postoperative median score of 80% (being able to perform normal activity with only moderate symptoms). The New York Heart Association classification improved a median of 2 classes in this group. These benefits were sustained at the 3-month follow-up.
Conclusion Although greater resource expenditure is required for the initial perioperative convalescence, octogenarians can be expected to have an excellent functional outcome and long-term performance status after cardiac valve surgery.
From the Department of Cardiothoracic Surgery, University of California, San Francisco.
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