Preoperative and intraoperative factors associated with long-term survival in octogenarian cardiac surgery patients.

Background: The proportion of octogenarians undergoing cardiac surgery is increasing though few studies have examined the simultaneous impact of preoperative and intraoperative factors on long-term survival in this age group. This study aimed to describe the preoperative clinical and demographic characteristics associated with long-term mortality risk and determine whether intraoperative factors related to surgical and cardiopulmonary bypass techniques impacted upon these.

Methods: Octogenarians undergoing coronary artery bypass grafting (CABG) +/- concomitant valvular procedure between 1992 and 2005 from three institutions were included in this study. The survival data of 606 octogenarians (414 isolated CABG, 192 concomitant valve procedures) were analyzed with multivariable proportional hazard models.

Results: There were 271 deaths and 2,675 person years of survival for analysis, and median follow-up was 7.15 years (95% confidence interval 6.47 to 7.82 years). Five-year survival for isolated CABG and concomitant valve procedures was 66.5% and 61.5%, respectively. An increase in mortality risk was attributable to older age, hypercholesterolemia, severely impaired left ventricular function, tobacco smoking history and high creatinine (> or = 0.15 mmol/L). Time spent on cardiopulmonary bypass was the only intraoperative risk factor associated with an increase in mortality risk (hazard ratio 1.01, 95% confidence interval: 1.00 to 1.02; p < 0.001).

Conclusions: This study showed that from the intraoperative parameters examined only time spent on cardiopulmonary bypass was associated with long-term survival. Surgeons may be assisted in patient selection by identifying the factors that influence long-term survival among octogenarians and development of a preoperative risk model specific for this age group.