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78 Heart, Lung and CirculationAbstracts of the ASCTS Annual Scientific Meeting 2007 2009;18:65–88

TAG PRIZE ENTRANTS

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Long-term quality of life in octogenarians after cardiacsurgery

Scott Graham, Hugh Cullen, John L. Knight, Robert A.Baker

Cardiac and Thoracic Surgery, Flinders Medical Centre andFlinders University, Adelaide, Australia

Introduction: Coronary and valvular heart disease arecommon conditions with substantial morbidity and mor-tality. The number of elderly people in the Australianpopulation is rapidly increasing, with 25–40% of octo-genarians suffering from symptomatic cardiovasculardisease [1]. As such, cardiac surgeons are asked to con-sider those of advanced age for surgery at an increasingfrequency. The survival outcomes of surgery in octogenar-ians have been shown to be good [2]. Information on thelong-term quality of life of octogenarian patients is lack-ing. The aim of this study was to obtain data on the qualityof life in octogenarian patients who had cardiac surgery.

Methods: The surgical cohort included patients whowere 80–89 years of age at operation, having cardiacsurgery between 1992 and 2003 at Flinders Medical Centre,Flinders Private Hospital and Ashford Community Hospi-tal. We identified 632 patients of whom 321 were alive at the

establishing predictors of good quality of life outcomes inthis age group are required.

Reference

[1] Akins CW, Daggett WM, Vlahakes GJ, et al. Ann Thorac Surg1997;64:606–14.

[2] Hewitt TD, Santa Maria PL, Alvarez JM. ANZ J Surg2003;73:749–54.

doi:10.1016/j.hlc.2008.11.036

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Minimally invasive cardiac surgery

K.S. Rathore, M. Worthington, R. Stuklis, J. Edwards

Department of Cardiothoracic Surgery, Royal Adelaide Hospi-tal, Adelaide, SA, United States

Introduction: Minimally Invasive Cardiac Surgery(MICS) is an exciting new technology introduced abouta decade ago but because of perceived difficulty hasnot been adopted widely. At the Royal Adelaide andWakefield Hospitals in Adelaide we are in the thirdyear of our MICS program. Initially the da Vinci Roboticsystem was employed but, as in other institutions, was

beginning of this study. Survival status was determinedusing National Death Index data from the Australian Insti-tute of Health Welfare. From this group, 161 interviews(50.1% of survivors) were successfully performed. Follow-up information was obtained from medical records and astructured telephone questionnaire.

Results: Operative mortality was 6.5% for all-comers.Survival rate for hospital survivors at 5-years after surgerywas 66.6%. The mean time to interview was 5.5 years.Respondents were asked to rate their current overallhealth; 47.2% rated their current health as “very good”or better, with 48.1% believing that their health was “bet-ter now” in comparison to their health at the time of theirsurgery; 76.4% had experienced some chest pain, whilst45.0% had experienced some breathlessness since theiroperation. Questions targeted at physical ability identi-fied 53.4% of patients who could walk a distance of half amile unaided. With respect to resource utilisation, 26.8%were entirely independent with activities of daily living.When assistance was required, the main areas of needwere mobilisation away from home (26.0%) and takinga bath or shower (17.7%). Importantly, 96.2% of patientsbelieved that their cardiac surgery had been worthwhile(75.9% strongly agreed).

Discussion: Our study supports the performance of car-diac surgery in octogenarians. Favorable findings weredemonstrated with respect to resource utilisation, despitethe advanced age of participants and their disease burden.Favourable quality of life was obtained by the majority ofpatients. This study shows a satisfactory long-term out-come and quality of life in patients who have cardiacsurgery during their ninth decade of life. Further research

abandoned in favour of direct access surgery using longshafted instruments. Particular stimulus was provided byour visits to Prof. Mohr’s group in Leipzig, Germany. Aswith all new technology and surgical techniques we haveconducted a rigorous and ongoing audit. In this paper wepresent our results.

Material and methods: Included are all the patients whohad minimally invasive surgery from September 2006onwards without the da Vinci system. Operations includedare isolated mitral valve disease, intracavitory tumours;redo surgery and tricuspid valve disease. Demographicdata, preoperative echocardiography, catheterisation data,operative findings and post-operative follow up data wasall collected prospectively.

Results: There were 65 patients, the majority were male(40), with a mean age of 60.58 ± 2.45 years and weightof 80.12 ± 4.32 kg. The majority of patients had degener-ative disease with 58 having regurgitant pathology. Sixtypatients had mitral valve surgery (52 were repaired, 8 werereplaced). Left atrial myxoma excision were performed in 4cases and tricuspid valve replacement in 1 patient. Associ-ated procedures were cryoablation (8), ventricular septaldefect closure (1), patent foramen ovale closure (1). Fivecases had previous median sternotomy. These 5 patientswere done without aortic cross clamp and beating heart.

Two in hospital mortalities occurred with 1 stroke and1 permanent pacemaker insertion. Ventilation time was8.2 ± 1.52 h, ICU stay was 1.85 ± 1.12 days. Six patients hadpost-operative atrial fibrillation. They all had low painscore and can be mobilised very early. There were nowound infections. Blood transfusion was rare. Pre dis-charge echocardiography showed 1 with moderate MRand 5 with mild MR. No patient required redo valve repair.