Personalisierte Indikationen in der Herz-Thorax-Chirurgie: Warum nicht einen komplexen chirurgischen Eingriff bei einem gebrechlichen Achtzigjährigen durchführen?

The World Health Organization recently noted deteriorating health outcomes in a cardiac surgery unit, hinting at potential changes in cardiac surgeons’ practice due to rapidly ageing populations. Researchers from Newcastle found that none of the 1042 octogenarians randomly selected for a cross-sectional study were entirely free from health issues. More than half had cardiovascular disease (CVD) with an average of 5 and 4 chronic diseases in women and men, respectively. This indicates an increasing demand for cardiovascular treatment among those aged 80+ years who may have up to 3–5 age-related chronic conditions at the time of surgery. The increased mortality rate among older CVD patients, together with clinical decisions largely based on data from younger adults who are routinely included in landmark studies, underlines the complexity of cardiac surgery. Despite these challenges, positive short-term and long-term treatment results are achievable in older patients. Risk assessment tools, such as the Society of Thoracic Surgeons (STS) score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, play a crucial role in predicting early outcomes but often overestimate risks in older patients and underestimate those in frail patients. The concept of frailty, characterized as heightened vulnerability due to deteriorations across multiple physiological systems, emerged more than 30 years ago. Approximately 30% of people aged 80 years and over fit into this frailty category. The use of various tools to measure frailty can assist clinicians in re-evaluating treatment plans, emphasizing the need for standardized measurements and further research on frailty measurements to improve perioperative outcomes. The effectiveness of high-performance teams in foreseeing surgical complications and patient selection cannot be overstated. These teams consistently demonstrate remarkable outcomes in older patients, with low mortality rates and significant home discharge rates. As a result, achieving superior patient outcomes becomes a realistic goal when skilled professionals strategically plan and tailor procedures to fit each patient’s individual characteristics. The integration of their accumulated experience and the adoption of various forms of advanced technology creates a critical element to achieve optimal patient outcomes.