Determinants of survival following cardiac operations in elderly patients.

Ninety-four cardiac operations were performed on 92 patients 65 years of age and over at the Peter Bent Brigham Hospital, Boston, from July 1970 to July 1974. There were 39 aortic valve replacements, 11 mitral valve replacements, 14 double valve operations, 16 coronary revascularizations, five repairs of aortic dissections, and one atrial septal defect closure. The operative mortality was 11 percent in elective cases and 40 percent in the emergency cases, an overall mortality of 17 percent. There were no hospital deaths following elective double valve operations or coronary bypass procedures. Combined hospital and late mortality of ventricular aneurysmectomy approached 100 percent. Myocardial infarction accounted for eight of the 16 hospital deaths. The overall late mortality has been 7.5 percent. Ninety-seven percent of surviving patients are functional class 1 or 2 with a follow-up of 4 to 48 months. These data suggest that any necessary cardiac surgery, excepting ventricular aneurysmectomies, may be performed electively with low risk and a high likelihood of satisfactory rehabilitation in the elderly age group. The major determinants of mortality are the urgency of the intervention and associated coronary artery disease.