Preoperative transthoracic echocardiography in patients older than 90 years undergoing noncardiac surgery

Kim, Yoo Ri; Cho, In Jeong; Shin, Gil Ja; Pyun, Wook Bum

Abstract

BACKGROUND/AIMS: Adverse cardiac events pose a significant perioperative risk to patients undergoing noncardiac surgery, especially geriatric patients. This study presents resting echocardiography data for a population older than 90 years.
METHODS
We performed transthoracic echocardiography in 108 patients who were older than 90 years and scheduled to undergo noncardiac surgery between November 1, 2004, and September 22, 2008, and evaluated their medical histories and electrocardiograms.
RESULTS
The 108 patients included 73 (67.3%) women and 35 (32.7%) men with a mean age of 92.0+/-2.77 years (range 90-104). Their medical histories included hypertension in 38.9% and diabetes mellitus in 15.7%. The average left ventricular end diastolic dimension and ejection fraction were 49.0+/-6.3 mm and 62.9+/-11.1%, respectively. Six (5.6%) patients had clinically significant aortic regurgitation and seven (6.5%) had mitral regurgitation as pathologic changes of aging. Six patients had mild to moderate aortic stenosis, found incidentally, that did not affect the clinical decision regarding the scheduled operation. The diastolic parameters showed that most of the patients (87%) had grade I relaxation abnormalities. The average mitral inflow E/A, deceleration time, and E/E's were 0.69+/-0.33, 266+/-82 msec, and 11.15+/-3.88, respectively.
CONCLUSIONS
Echocardiography cannot predict all of the postoperative cardiovascular complications and risks, but it is useful for screening for significant left ventricular dysfunction, valvular abnormalities, and as a guide for managing extremely old patients in the perioperative period.