冠状动脉旁路移植同期行心脏瓣膜手术的临床研究(附57例报告)

目的:介绍同期施行冠状动脉旁路移植术和瓣膜手术的体会。方法:2000年12月至2006年3月,57例冠状动脉旁路移植术同期行瓣膜手术,患者年龄43~81岁,平均60·5岁,术前心功能(NYHA)Ⅱ级19例,Ⅲ级31例,Ⅳ级7例;二尖瓣病变29例,主动脉病变13例,联合瓣膜病变15例,瓣膜病病因中,风湿性31例,退行性13例,缺血性9例,二瓣化畸形4例。共搭桥103支,平均1·8支,根据患者的年龄及病变血管情况选用乳内动脉、桡动脉及大隐静脉做血管桥。行二尖瓣成形17例,二尖瓣置换12例;主动脉瓣成形10例,主动脉瓣置换12例,二尖瓣和主动脉瓣双瓣置换术6例,同时行三尖瓣成形13例。术中放置经食管超声监测检测瓣膜成形效果。结果:术后早期死亡3例;术后并发症为出血、低心排出量综合征、肾功能不全、肺部感染和小面积脑梗塞。术后6个月复查心脏彩超,瓣膜成形效果满意;术后随访平均13·5个月,无明显心绞痛复发,心功能改善。结论:风湿性瓣膜病患者,有冠心病高危因素的患者,术前应常规行冠状动脉造影检查。缺血性二尖瓣关闭不全患者行瓣膜成形,手术效果满意。综合使用多种成形技术行主动脉瓣成形,取得较好的近中期效果。术中经食管超声检测并结合注水试验对于了解成形术的效果有重要意义。充分的术前准备,恰当地使用主动脉内球囊反搏(IABP)及床旁血滤可提高手术成功率。     

高龄、高危心脏瓣膜病人瓣膜置换28例治疗观察

目的 总结高龄和高危心脏瓣膜病人行瓣膜置换术的疗效,探讨影响手术疗效因素及手术适应证.方法 2000年3月～2005年10月,共行高龄（年龄超过65岁）和高危心脏瓣膜置换术28例：单纯二尖瓣置换17例;主动脉瓣置换3例;二尖瓣及主动脉瓣置换6例;行二尖瓣置换及冠状动脉旁路移植术2例.同期行三尖瓣成形术21例.结果 术后早期并发症18例;晚期死亡1例,死因为肺出血.术后2周、3个月复查超声心动图示各心腔内径较术前明显缩小.随防出院者时间3～36个月,术后心功能Ⅰ～Ⅱ级27例,Ⅲ级1例.结论 提高高龄和高危心脏病人手术疗效的关键是选择合适手术时机,妥善处理围术期和术后高危因素.     

65岁以上老年患者心脏瓣膜手术中的体外循环管理

【目的】 总结65岁以上老年人心脏瓣膜置换术的体外循环管理方法。【方法】 2006年1月至2008年12月,开展了232例老年人心脏瓣膜置换术,其中男133例,女99例,年龄65～78岁(69.6±9.2)岁;体重39～81Kg（51±8.2）Kg。手术方式包括二尖瓣置换术(MVR)73例,主动脉瓣置换术(AVR)51例,三尖瓣置换( TVR)3例,二尖瓣及主动脉双瓣置换术(DVR)93例,再次二尖瓣置换术(Re-MVR)7例,再次主动脉瓣置换术(Re-AVR)3例,主动脉带瓣人造血管置换2例,同期行二尖瓣整形(MVP)21例,三尖瓣整形( TVP)66例,冠状动脉旁路移植术(CABG)12例。全部采用气管插管、静吸复合麻醉,中度血液稀释、中度低温、中高流量,冷含血停跳液进行心肌保护,全部应用超滤器。【结果】：体外循环时间46～315min(87.2±32.7)min;主动脉阻断时间25～168min(58.3±27.5)min。转流中平均动脉压维持在6O～90mm Hg,超滤量为800～8300ml,心脏自动复跳率86％,本组早期死亡10例(4.3％)。【结论】 体外循环中加强心肌保护;控制血液稀释度,使用血液超滤技术维持机体内环境的稳定;有效的组织灌注以及良好的保护等综合性措施,有助于脑、肾、肺等重要脏器的保护,有利于提高老年患者心脏瓣膜置换术中体外循环的质量,并确保手术安全     

St．Jude人工机械瓣膜临床应用20年经验总结

方法 1979年1月至2000年12月,共随访837例瓣膜置换患者,年龄19～84岁,包括主动脉瓣置换478例(378例置换标准St.Jude瓣,78例置换Master系列瓣,22例置换HP系列瓣),其中术前心功能NYHA分级Ⅲ～Ⅳ级,同期行冠状动脉旁路移植术(CABG)150例;二尖瓣置换359例(266例置换标准St.Jude瓣,93例置换Master系列瓣),其中有369例术前心功能NY-     

冠状动脉旁路移植术同期心脏瓣膜术治疗心脏瓣膜病的临床观察

目的探讨冠状动脉旁路移植术同期心脏瓣膜手术的临床治疗效果。方法选取2011年1月2013年1月冠状动脉旁路移植术同期心脏瓣膜手术患者20例，对其临床资料进行回顾性分析。结果术后早期死亡3例，死亡率为15．0％，其中1例患者因左室破裂死亡，1例因多器官功能衰竭死亡，1例因呛咳导致室颤死亡。对余下17例患者手术治疗，随访3个月～18个月，患者心功能得到有效改善，无严重心绞痛发生。结论风湿性瓣膜病患者，且存在冠心病高危因素，则应进行冠状动脉造影检查，缺血性二尖瓣关闭不全的患者，如果瓣膜成形效果不显著，则应保留瓣下结构的瓣膜置换。     

心脏瓣膜替换并冠状动脉旁路移植同期施行手术40例报告

目的:探讨心脏瓣膜替换并冠状动脉旁路移植同期手术指征、方法及围术期处理。方法:2003年1月至2008年12月我院同期施行心脏瓣膜替换并冠状动脉旁路移植手术40例,其中风湿性心脏瓣膜病并冠状动脉病变35例;冠心病并缺血性二尖瓣关闭不全2例,主动脉瓣退行性变3例;冠状动脉造影显示单支血管病变20例,双支12例,多支8例,施行二尖瓣替换29例,主动脉瓣替换7例,二尖瓣替换+主动脉替换4例,同期施行三尖瓣成形10例,左心房血栓清除6例,室壁瘤切除3例。结果:全组病例无早期死亡,术后发生低心排出量综合征6例,呼吸衰竭3例,脑栓塞3例,肾功能衰竭1例。术后随访30例,随访时间1~60个月,除1例术后5年死于肝癌外,其余心功明显改善。结论:心脏瓣膜替换并冠状动脉旁路移植同期手术可获得良好效果。彻底解除瓣膜病变,充分心肌再血管化,良好的心肌保护和术后处理是获得手术成功的关键。     

同期行冠状动脉旁路移植术与瓣膜手术23例

目的分析同时行冠状动脉旁路移植术和心脏瓣膜手术的治疗效果。方法23例患者同时行瓣膜手术与冠状动脉旁路移植术,平均年龄63.3(41～81)岁。瓣膜病变8例为风湿性,10例为瓣膜退行性病变,5例为缺血性二尖瓣反流。术前心功能(NYHA)Ⅱ级6例、Ⅲ级13例、Ⅳ级4例。手术在中度低温体外循环下进行,心脏停跳后,先做静脉桥的远端吻合,然后置换瓣膜。静脉桥与升主动脉的近端吻合在升主动脉一次阻断下或心脏复苏后完成。乳内动脉的吻合在换瓣后心脏复苏前完成。5例行二尖瓣成形,18例行瓣膜置换(使用生物瓣与机械瓣者分别为7例及11例,其中主动脉瓣置换12例、二尖瓣置换4例、双瓣置换2例)。结果术后呼吸机使用时间平均28.2(11￣247)h,平均ICU停留3.1(1￣34)d。4例患者因发生低心排综合征而行主动脉内球囊反搏(IABP),其中死亡1例。1例发生脑梗塞,1例置入永久起搏器。术后心功能Ⅰ级15例、Ⅱ级7例,均较术前明显改善。随访3￣55个月,术后均无心绞痛发作,未发生与抗凝相关的出血或血栓、栓塞事件。1例术后第4年死于恶性肿瘤。结论冠状动脉旁路移植术同时行瓣膜手术是安全、有效的。彻底纠治瓣膜病变、充分心肌再血管化和心肌保护是手术成功的关键。     

经胸骨下段正中小切口行心脏瓣膜手术

目的：探讨经胸骨下段正中小切口行各种心脏瓣膜手术的适应证和手术方法。 方法：３０例患者平均年龄４２．２±１０．１（１７～５８）岁。皮切口自第３胸肋关节水平至剑突根部,平均长度１１（９～１３）ｃｍ,自下而上纵行劈开胸骨至第２肋间处向右侧横断。手术于常规体外循环下进行,包括二尖瓣置换１９例,主动脉瓣置换３例,主动脉瓣及二尖瓣双瓣置换６例,二尖瓣Ｃａｒｐｅｎｔｉｅｒ环成形２例。７例同时行三尖瓣ＤｅＶｅｇａ环缩术。４例同时行左心房血栓清除。 结果：无手术死亡及并发症。平均主动脉阻断、体外循环和手术时间分别为５４．５±２４．９分、７９．２±２８．７分和１６０．９±４４．３分,术后呼吸机辅助１０．７±４．２小时,住院时间 １４．４±４．９天。术后胸液量２８２±１２５（５０～６３０）ｍｌ,有１６例患者（５３．３％）未输血。 结论：经胸骨下段正中小切口行心脏瓣膜手术安全可靠,美观,创伤小,出血少,保留了胸廓的连续性,早期结果满意。     

重危瓣膜病变合并巨大心脏的外科治疗

目的:报道181例重危瓣膜病变合并巨大心脏的外科治疗体会。方法:回顾性分析181例瓣膜外科病例中合并巨大心脏临床资料,男性76例,女性105例,年龄15～57岁,平均(45.7±15.2)岁。分为2组:巨大左心房(GLA)组84例,左心房内径(LAD)70～150mm,平均(80.3±17.5)mm;巨大左心室(GLV)组97例,左心室舒张末内径(LVEDD)70～112mm,平均(79.4±12.7)mm。患者全部行瓣膜置换术,其中GLA组行主动脉瓣与二尖瓣双瓣膜置换术12例,二尖瓣置换术72例,同期行三尖瓣环缩成形术42例,左心房血栓清出13例;84例均作左心房折叠术。GLV组行主动脉瓣置换术38例,主动脉瓣与二尖瓣双瓣膜置换术27例,二尖瓣置换术32例,二尖瓣置换术均保留全部或部分瓣膜和瓣下结构,同期行三尖瓣环缩成形术18例,左心房血栓清出4例,左心房折叠术21例。结果:手术早期死亡率GLV组和GLA组分别为9.3%和6.0%,GLV组明显高于GLA组(P<0.05);死亡原因GLV组以室性心律紊乱为主(55.6%),明显高于GLA组(P<0.05);GLA组以呼吸衰竭为主。术后1个月超声心动图显示,GLA组LAD平均(60.1±12.1)mm,GLV组LVEDD平均(56.6±16.1)mm,较术前明显缩小(P<0.01)。心功能恢复良好。结论:瓣膜置换同期左心房折叠术有利于改善合并巨大左心房的术后恢复;保留二尖瓣瓣膜及瓣下结构有利于合并巨大左心室病例的恢复。     

IABP在重症心脏瓣膜置换术的应用

目的 总结主动脉内球囊反搏泵（IABP）在重症心脏瓣膜置换术后的应用经验。方法 回顾分析茂名市中医院心胸外科近10年来应用1ABP治疗重症心脏瓣膜置换术后出现的低心排出量综合征,其中男性7例、女性2例, 年龄45～71（55.20±9.60）岁,术前诊断为风湿性心脏瓣膜病;其中冠脉造影明确合并冠心病1例,术前心脏超声检查巨大左心房4例,左心房血栓2例,三尖瓣重度关闭不全并中重度肺动脉高压8例;心功能NYHA分级Ⅲ级2例、Ⅳ级7例。其中二尖瓣置换 左房折叠 三尖瓣成形2例,二尖瓣置换 三尖瓣成形3例,主动脉瓣置换1例,二尖瓣 主动脉瓣置换 三尖瓣成形2例,冠状动脉旁路移植术 二尖瓣置换 三尖瓣成形1例。比较IABP使用前、后心率（HR）,有创平均压（MABP）,中心静脉压（CVP）,动脉氧分压（PaO2）,乳酸（Lac）,尿量和肾上腺素用量。结果 全组患者行IABP辅助治疗时间48～196（64.2±25.6）h,使用IABP后,HR、MABP、CVP、PaO2、Lac、尿量及肾上腺素用量与使用后有明显差异（P<0.05）;本组存活5例,死亡4例,死亡原因分别为低心排出量综合征(2例)、多脏器衰竭（2例）,无IABP相关并发症。结论 IABP是成功抢救重症心脏瓣膜置换术后低心排的有效措施,及时应用IABP可以提高手术的成功率。     

冠心病合并中重度缺血性二尖瓣关闭不全的外科治疗

目的探讨冠心病合并中重度缺血性二尖瓣关闭不全的外科治疗原则。方法选择冠心病合并中重度缺血性二尖瓣关闭不全的手术患者61例,并对患者的临床资料进行回顾性分析。结果 45例行冠状动脉旁路移植术+二尖瓣成形术,16例行冠状动脉旁路移植术+二尖瓣置换术,其中2例患者行二尖瓣置换术,术后早期死于心力衰竭,余59例均治愈岀院。术后复查超声心动图检查显示,左心室舒张末内径从(52.8±11.3)mm降至(47.9±8.9)mm(P<0.01),LVEF从(46±11)%升至(52±12)%,差异有统计学意义(P<0.01)。结论对于冠心病合并中重度缺血性二尖瓣关闭不全的手术患者,同期处理二尖瓣后效果满意。     

CABG同期二尖瓣置换与二尖瓣成形术治疗冠心病合并Ⅲb型缺血性二尖瓣反流患者的疗效比较

目的 对比分析冠状动脉旁路移植术(coronary artery bypass grafting,CABG)同期行二尖瓣置换术(mitralvalve replacement,MVR)与二尖瓣成形术(mitral valvuloplasty,MVP)治疗冠状动脉粥样硬化性心脏病(冠心病)合并Ⅲb型缺血性二尖瓣反流(is...     

经右胸微小切口微创心脏瓣膜手术

目的 探讨右胸微小切口（4～5 cm）微创心脏瓣膜手术的可行性和优越性.方法 回顾性分析经右胸微小切口（4～5 cm）微创心脏瓣膜手术89例的临床资料,其中男性38例,女性51例,对手术方法、主要并发症和手术适应证进行分析总结.结果 本组手术包括MVR 50例,MVP 11例,MVR＋TVP＋MAZE 2例,MVR＋PFO缝闭3例,MVR＋赘生物清除2例,MVR＋ASD修补＋TVP 3例,MVR＋TVP 8例;AVR 8例;MVR＋AVR 2例.右胸切口长度4～5 cm.术后并发症包括：二次开胸止血6例,伤口延迟愈合5例.无神经系统并发症,无肺部并发症,无肝肾功能不全.89例患者均痊愈出院.结论 掌握好手术适应证,经右胸微小切口行微创心脏瓣膜手术是安全可行的,疗效满意,创伤小,恢复快,切口美观,患者满意度高.     

The risk of reoperative heart valve procedures in Octogenarian patients

BACKGROUND AND AIM OF THE STUDY: The authors' experience is reported of cardiac reoperations for valvular heart disease in octogenarian patients. METHODS: The records of 22 consecutive patients (10 men, 12 women) aged > or =80 years (mean age 82.4+/-2.3 years) who underwent cardiac reoperation for aortic and/or mitral valvular heart disease at the authors' institution between 1991 and 2001 were retrospectively reviewed. RESULTS: Indications for reoperation were structural dysfunction of a previously implanted bioprosthetic valve in 11 patients (50%), new valvular heart disease in six (27%), progression of rheumatic valvular heart disease in four (18%), and prosthetic valve infective endocarditis in one patient (5%). Fourteen patients (64%) underwent isolated aortic valve replacement (AVR), two (9%) had AVR plus coronary artery bypass grafting (CABG), one patient (5%) had aortic root replacement plus CABG, three patients (14%) had isolated mitral valve replacement (MVR), one patient (5%) had MVR plus ascending aorta replacement, and one (5%) had AVR plus MVR. Postoperative complications occurred in 18 patients (82%). The hospital mortality rate was 32%. Actuarial survival estimates at one year, and at three and five years were 62.6%, 56.3% and 40.2%, respectively. CONCLUSION: Cardiac reoperations for valvular heart disease in octogenarians carry a high postoperative morbidity and mortality. These findings must be taken into account in the management of associated mild or moderate valvular heart disease, and in the choice of heart valve prosthesis at the initial operation in younger patients.     

Cardiac surgery in octogenarians: a six-year follow-up with a multidimensional intervention]

BACKGROUND: Elderly subjects frequently experience a decline in function following hospitalization and surgery. Specific changes in the provision of acute hospital care can improve the ability of acutely ill older patients to perform activities of daily living at the time of discharge and the quality of life. The aim of this study was to investigate outcomes of older (age > or =80 years) cardiac surgery patients managed with multicomponent intervention. METHODS: Between 1998 and 2004, we studied records of 193 octogenarian patients who underwent cardiac surgery and were treated with a multicomponent intervention that included: specially designed environment, patient-centered care, planning for patient discharge at home, and an interdisciplinary approach that incorporates in- and out-of-hospital health professionals. RESULTS: Mean follow-up was 26.4 months and 100% complete. Mean age of patients was 82.3 +/- 2 years. Eighty-nine patients had myocardial revascularization (CABG), 40 aortic valve replacement (AVR), 34 AVR + CABG, 8 mitral valve replacement (MVR), 11 MVR + CABG and 11 other interventions. Rates of hospital death, major complications and prolonged stay (> 14 days) were as follows: CABG 4 (4.4%), 3 (3.3%), 6 (6.4%); AVR 1 (2.5%), 3 (7.5%), 2 (5%); AVR + CABG 1 (2.9%), 2 (5.8%), 4 (11.7%); MVR 0 (0%), 0 (0%), 1 (12.5%); MVR + CABG 2 (18.1%), 2 (18.1%), 3 (27.2%). Multivariate predictors of hospital deaths were NYHA class, cardiopulmonary bypass and cross-clamping time, urgent procedure and ischemic mitral valve procedures. The actuarial 6-year survival was as follows: CABG 91%,AVR 92.5%, AVR + CABG 88.2%, MVR + CABG 81.8%. Total survival rate, free from rehospitalization and redo surgery, was 89.7, 69.8 and 99% respectively. Multivariate predictors of late death were urgent procedure and ischemic mitral valve procedures. At follow-up NYHA classification had improved a median of two classes. Global patients' satisfaction was excellent in 76.7% of survivors; 95.7% were autonomous, 40.5% live at home, 64% had a light-moderate physical activity, and 70% of patients had good social relationships and quality of life. Medical therapy was reduced in 29.3% and level of anxiety improved in 76%. CONCLUSIONS: An interdisciplinary approach and multicomponent intervention with an appropriate postoperative care, provides beneficial effects on outcome in geriatric cardiac surgery patients.     

Prediction of operative mortality after valve replacement surgery.

OBJECTIVES: We sought to develop national benchmarks for valve replacement surgery by developing statistical risk models of operative mortality. BACKGROUND: National risk models for coronary artery bypass graft surgery (CABG) have gained widespread acceptance, but there are no similar models for valve replacement surgery. METHODS: The Society of Thoracic Surgeons National Cardiac Surgery Database was used to identify risk factors associated with valve surgery from 1994 through 1997. The population was drawn from 49,073 patients undergoing isolated aortic valve replacement (AVR) or mitral valve replacement (MVR) and from 43,463 patients undergoing CABG combined with AVR or MVR. Two multivariable risk models were developed: one for isolated AVR or MVR and one for CABG plus AVR or CABG plus MVR. RESULTS: Operative mortality rates for AVR, MVR, combined CABG/AVR and combined CABG/ MVR were 4.00%, 6.04%, 6.80% and 13.29%, respectively. The strongest independent risk factors were emergency/salvage procedures, recent infarction, reoperations and renal failure. The c-indexes were 0.77 and 0.74 for the isolated valve replacement and combined CABG/valve replacement models, respectively. These models retained their predictive accuracy when applied to a prospective patient population undergoing operation from 1998 to 1999. The Hosmer-Lemeshow goodness-of-fit statistic was 10.6 (p = 0.225) for the isolated valve replacement model and 12.2 (p = 0.141) for the CABG/valve replacement model. CONCLUSIONS: Statistical models have been developed to accurately predict operative mortality after valve replacement surgery. These models can be used to enhance quality by providing a national benchmark for valve replacement surgery.     

风湿性心脏病合并冠心病的同期外科治疗

目的 探讨风湿性心脏病合并冠心病的同期外科治疗,提高手术效果.方法 回顾性分析9例患者同期施行冠状动脉旁路移植术和心脏瓣膜手术的临床资料及远期随访资料,其中二尖瓣置换6例,二尖瓣成形2例,主动脉置换1例.合并冠状动脉单支病变中7例用左乳内动脉做血管桥,二支病变中1例用左乳内动脉加大隐静脉做血管桥,1例用左乳内动脉加左桡动脉做血管桥.结果 术后平均呼吸机辅助时间19 h,平均重症监护室监护时间2.6天,出院前行超声检查心功能,射血分数上升0%～20%.发生呼吸功能不全3例,严重心律失常3例,出血再次开胸1例,经治疗均好转.心绞痛不同程度消失,无围手术期死亡,远期随访心功能明显改善.结论 积极、正确的围手术期处理, 改善心功能,尽量缩短主动脉阻断时间,术中心肌保护良好,是提高瓣膜病合并冠心病患者手术成功率、降低死亡率、减少并发症的关键.     

Changes in the pulmonary capillary pressure after cardiac surgery

The changes in the pulmonary circulation in 37 cardiac surgery patients undergoing coronary artery bypass (CABG), n = 16; aortic valve replacement (AVR), n = 13; and mitral valve replacement (MVR), n = 8 were studied. The visual technique for the determination of pulmonary capillary pressure (Pc) was used in the preoperative and postoperative periods. The ratio of Pc to the pulmonary artery wedge pressure (Pw) was calculated to determine whether Pc and Pw varied independently. In addition, total pulmonary vascular resistance (PVR) was divided into precapillary (ra) and postcapillary (rv) components. Results from the CABG patients showed that the relationship between Pc and Pw remained constant despite an increased cardiac output. This differs from the data obtained from AVR and MVR patients in whom the Pc/Pw ratio was significantly higher after surgery. Therefore, Pw would underestimate Pc in this group of patients. In addition, MVR patients showed a significant postoperative increase in PVR and rv as compared with their preoperative values. This was also significantly higher than the rv in either AVR or CABG patients. The etiology of this change is unknown.     

The effect of glutamate and aspartate on myocardial protection at cardiopulmonary bypass]

OBJECTIVE: To determine whether glutamat and aspartat enriched cold crystalloid cardioplegia which was given in antegrade way has any effect on the myocardial protection during cardiopulmonary bypass. METHODS: Thirty-four patients who were electively undergone open heart surgery at Osmangazi University Faculty of Medicine, thoracic and cardiovascular surgery department, between March 2001 and May 2001 were included in this study. The patients were divided in two groups, each consisting of 17 patients. In group 1 coronary artery bypass surgery (CABG) was performed in 11 patients, mitral valve replacement (MVR) in 3 patients, aortic valve replacement (AVR) in 1 patient and AVR and MVR in 2 patients. While in group 2 CABG was performed in 13 patients and MVR was done in 4 patients. Group 1 patients received antegrade glutamat and aspartat (15 mmol/L) enriched cold crystalloid cardioplegia and group 2 patients were given cold crystalloid cardioplegia by antegrade route. Age, gender, diabetes mellitus, hypertension, preoperative myocardial infarction, smoking, ejection fraction, aortic cross-clamp time, need to defibrillation, inotropic support, and intraaortic balloon pump were recorded. The levels of cardiac troponin I (cTI) and creatine kinase myocardial band fraction (CK-MB) were measured in arterial blood samples at five different times. Statistical analysis was performed using Student's t-test and Chi-square test. RESULTS: There were no statistically significant differences in cTI and CK-MB values in blood samples taken at 5 different times pre and postoperatively between group 1 and group 2. CONCLUSION: It is concluded that glutamat and aspartat enriched cold crystalloid cardioplegia does not have any effect on myocardial protection.     

Cardiac surgery in patients over the age of 80 years

The risk-benefit relationship of open heart surgery in octogenarians is not well established. Eighty consecutive patients over the age of 80 who underwent cardiac operations under cardiopulmonary bypass were evaluated. Twenty-five patients were in functional class IV, 42 in class III, and 13 in class II. Forty-four patients had only coronary artery bypass grafts (CABG), 12 only aortic valve replacement (AVR), 6 only mitral valve replacement (MVR), 12 CABG and AVR, 4 CABG and MVR, 1 CABG and aneurysmectomy, and 1 had resection of left atrial myxoma. Operative mortality (within 30 days) was 12.5% for the group. Mortality was related to bleeding, left ventricular failure, primary ventricular fibrillation, pulmonary failure, and renal failure. Mortality was higher in patients with (1) advanced functional class, (2) mitral valve replacement, (3) postoperative hemorrhage, and (4) associated pulmonary disease. While a generally conservative approach is recommended for octogenarian patients, many with life-threatening cardiac disease, especially those free of major multisystem illnesses, should not be denied the benefit of surgical treatment.