Adult heart disease

Abstract

The surgical treatment of acquired cardiac diseases has become increasingly sophisticated in the past two decades-The expected mortality of most cardiac operations in adults has been reduced to extremely low levels-despite the fact that increasingly higher-risk patients are now candidates for surgery. 1-3 In this regard, it is important to recognize that 75% of patients undergoing coronary bypass surgery in the Coronary Artery Surgery Study (CASS) in the late 1970s had an ejection fraction that was greater than 50%, and all patients were younger than 65 years of age, while in the Society of Thoracic Surgery (STS) database for coronary artery bypass in 2002, the average patient age was 67 years, and the average ejection fraction was 45%. Despite the reality of increasingly higher-risk patients undergoing coronary bypass surgery, the observed operative mortality for coronary bypass surgery in the 2002 STS database was 2.8%. Similarly, morbidity associated with coronary bypass surgery was found to have decreased from 1986 to 1994 in a series of nearly 8000 patients reported from the Cleveland Clinic, despite a significant rise in the patient risk profile in this series.3 Similar trends can be described for most facets of adult cardiac surgery. © 2008 Springer New York.