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Cardiovascular Surgery in the Elderly

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Cardiovascular Disease in the Elderly

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

The elderly represent a prominent, with improving life expectancies, rapidly expanding sector of the US population, with currently over 13 million people, and estimates that this number will quadruple in the next 50 years. [1, 2]. In large part, these demographic trends are attributable to improved modalities for preventing and managing cardiovascular disease (CVD) in young and middle-aged adults, which improved survival and delayed the onset of CVD until later in life. These improvements have resulted in an increase in the prevalence of CVD in the population and the incidence of CVD in older adults [3, 4]. CVD remains the leading cause of morbidity and mortality in the elderly, despite advances in medical therapies [5–8]. Elderly patients are thus undergoing more procedures to treat CVD, and the demographics of patients undergoing cardiac surgery, a validated means of increasing survival and improving quality of life, reflect this trend [9]. Compared to a younger cohort, the elderly population generally has higher rates of comorbid disease with lower functional reserve, ultimately predisposing them to a higher risk of complications and death. This increased risk, paired with the institutional and societal emphasis on procedural outcomes, has led many cardiologists and cardiac surgeons to only reluctantly recommend cardiac operations for elderly patients. With the advancement and proliferation of percutaneous technologies, many cardiac surgeons are nonetheless operating on older, sicker patients compared to their training and initial practice. For example, elderly patients comprise an increasingly prominent proportion of the population undergoing coronary artery bypass grafting (CABG), and the number of octogenarians undergoing CABG in the United States increased by 67% from 1987 to 1990 [10–12]. There has been a corresponding increase in the literature investigating the CABG outcomes for septuagenarians, octogenarians, and nonagenarians with varied conclusions due to small sample sizes and divergent institutional experiences [3, 5, 6, 10, 11, 13–16]. Regardless of this variance, most of the literature demonstrates that, despite increased costs and longer lengths of stay, cardiac operations can be performed with acceptable hospital mortality rates in carefully selected elderly patients.

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Authors and Affiliations

  1. Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    David Blitzer

  2. Department of Surgery, Division of Cardiac Surgery, Stamford Health, Stamford, CT, USA

    David D. Yuh

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  1. David Blitzer
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Correspondence to David D. Yuh .

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Editors and Affiliations

  1. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Thorsten M. Leucker

  2. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Gary Gerstenblith

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Blitzer, D., Yuh, D.D. (2023). Cardiovascular Surgery in the Elderly. In: Leucker, T.M., Gerstenblith, G. (eds) Cardiovascular Disease in the Elderly. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-16594-8_8

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  • DOI: https://doi.org/10.1007/978-3-031-16594-8_8

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