The changing face of cardiac surgery patients: an insight into a Mediterranean region

Eur J Cardiothorac Surg. 2010 Oct;38(4):407-13. doi: 10.1016/j.ejcts.2010.02.040.


Objectives: Data of 9 years of surgical activity (on about 10000 patients), obtained from the database of our cardiac surgery care centre, were analysed to assess time-related variations in demographics, clinical and surgical characteristics.

Methods: Data of patients submitted to major cardiac surgery procedures between 1999 and 2007 were examined using the chi-square test, analysis of variance (ANOVA) test or non-parametric tests, where applicable. The 'linear-by-linear' association test was used to verify the existence of a time-related trend. A value of p<0.05 was considered significant.

Results: In the time interval of 9 years, there was an increment of valve procedures and a decrease in coronary revascularisation surgery. Patients aged 75 years or more at the time of operation increased from 17% in 1999 to 29% in 2005, and the percentage of patients aged 80 or more demonstrated a threefold increase. Operated patients had more co-morbidity (the rate of hypertension rate 43.7% in 1999 and 68.9% in 2007, and obese patients were 13% in 1999 and 17.5% in 2007) and had worse functional and cardiac status (reduced ejection fraction (EF), haemodynamic instability and shock). As a consequence, there was an increased calculated surgical risk. At the same time, there was no significant increment in the observed mortality (3.1% in 1999 vs 3.8% in 2007 for all patients and 1.6% compared with 1.5% in isolated coronary artery bypass graft (CABG) patients).

Conclusions: These changes can reflect both a variation in the characteristics of the population and a major evolution in intervention cardiology and also impose more intensive and extensive postoperative treatment and less invasive cardiac surgery practice.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / mortality
  • Cardiac Surgical Procedures / statistics & numerical data
  • Cardiac Surgical Procedures / trends*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / surgery
  • Comorbidity
  • Coronary Artery Bypass / mortality
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Artery Bypass / trends
  • Epidemiologic Methods
  • Female
  • Heart Valve Diseases / epidemiology
  • Heart Valve Diseases / surgery
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged