Cardiac Surgery in Octogenarians Results in Subjective Gains but No Objective Improvements in Quality of Life or Functional Status after three Months

Abstract

Objective: To determine health related quality of life (HRQoL), functional status and re-admissions in patients 80 years and older three months after cardiac surgery Methods: Pilot prospective cohort study. Primary outcome measure: Change in HRQoL scores between baseline and three months following cardiac surgery Results: Sixty-three cardiac surgery patients were enrolled. The most frequent surgical procedures were CABG in 27 (43%), CABG + AVR/MVR in 18 (29%), AVR/MVR in 16 (25%). 61 (97%) were elective. Mean (SD) age was 83.2 (2.5) years, 56% were men, and mean (SD) length of hospital stay was 13.4 (5.9) days. Baseline self-reported co-morbidities included hypertension in 39 (62%), osteoarthritis in 27 (43%) and back pain in 21 (33%). and prosthetic heart valves with a significant risk of complications if treatment is delayed. Method: A retrospective analysis of 191 patients revealed nine patients who underwent valve replacement at The Townsville Hospital from 2008 until March 2011 with acute infective endocarditis. The outcome measures were native/prosthetic valve, indication for surgery, timing to surgery, and necessity for pre-surgical coronary angiogram. Results: A total of nine patients underwent valve replacement for active infective endocarditis. The average time to surgery fromonset of symptomswas 21.8 dayswith seven patients presenting to a peripheral centre. Themost common complication prior to surgical intervention was septic emboli (55%) followedbyheart failure (44%).Native valve endocarditis occurred in 66% of cases and surgery was performed on average 23.6.days after the onset of symptoms. Prosthetic valve endocarditiswas found in 33% and surgery was performed on an average of 18.3 days. None of the patients underwent cardiac catheterisation prior to surgery. One patients died following re-do valve surgery. Conclusion: Infective endocarditis requiring surgical managementwasmore common innative valveswith time to diagnosis being longer, compared to prosthetic valve endocarditis. Barriers to early surgery included late presentation to hospital and the need for transfer to a tertiary