European Journal of Cardio-Thoracic Surgery, Vol 12, 40-46, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Re-do cardiac surgery in patients over 70 years old
WI Awad, AC De Souza, PG Magee, RK Walesby, JE Wright and R Uppal
Department of Cardiothoracic Surgery, The London Chest Hospital, UK.
OBJECTIVE: This study was conducted in order to determine the outcome of
cardiac re-operations in patients over the age of 70. METHODS: All patients
who underwent 're-do' cardiac surgery at our institution, between January
1987 and October 1995 were identified. The case notes of patients over the
age of 70 were reviewed retrospectively and follow- up was by telephone.
RESULTS: A total of 687 re-do operations were performed during this 8 years
and 9 months period. Operations, 110 (16%) were on patients aged 70 years
and over (CABG 54, MVR 32, AVR 9, AVR + MVR 5, MVR + CABG 4, AVR + CABG 3,
repair of paraprosthetic leak 2 and closure of VSD 1). Operations, 63 (57%)
were elective and 42 (38%) were urgent. The median age was 73 years (range
70-82) and 64 patients (58%) were male. Pre-operatively, 78 patients (72%)
were NYHA functional class III/IV and 55 (50%) had angiographically
impaired left ventricular function (ejection fraction < 50%). The
overall operative mortality was 7% (8/110). Median ITU stay was one night
(range 1-21) and hospital stay was 7 days (range 5-35). Major in-hospital
complications included resternotomy in five patients (5%), permanent stroke
in three (3%), renal failure requiring haemodialysis in two (2%) and heart
block requiring permanent pacing in two (2%). At a median follow-up of 34
months (range 2-101), 69 of the 77 patients alive at follow-up (90%) were
NYHA functional class I/II. CONCLUSIONS: 'Re-do' cardiac surgery in
patients over the age of 70 carries an acceptable operative morbidity and
mortality with a good functional improvement at medium term follow-up.
