The current situation of cardiovascular surgery in elderly patients Age of surgery: With the extension of the average life expectancy, the emphasis on quality of life and the application of new materials and technologies, cardiovascular surgery in elderly patients over 70 years of age is increasing and has become a routine operation in many units in China, and the average age of adult cardiovascular surgery patients in Europe and the United States is close to 70 years, and surgery in patients over 80 years of age or even 90 years of age The number of reports is increasing. There is still some controversy about whether advanced age is an independent risk factor for cardiovascular surgery. It is generally believed that advanced age is not a contraindication to surgery, but should be combined with the patient’s systemic condition, important organ function, disease type and surgical approach for a comprehensive risk assessment. Types of surgery: Most of the cardiovascular surgeries in advanced age are coronary artery bypass grafting, followed by prosthetic valve replacement or valve repair and shaping, and simple CABG, simple aortic valve replacement or AVR with simultaneous CABG have good clinical results; in comparison, mitral valve surgery, combined valve disease surgery or mitral valve surgery with simultaneous CABG have poorer results, therefore, advanced age patients with coronary artery disease and/or aortic valve Indications for surgery can be relatively wide, while those for mitral valve surgery should be strictly grasped. Deep hypothermia, stopping circulation, prolonged extracorporeal circulation, and blocking the aorta are the basic techniques of aortic surgery, but all these technical aspects significantly increase the surgical risk in elderly patients; therefore, aneurysms and coarctation of the ascending aorta and arch are traditionally considered as contraindications for surgery in elderly patients. However, in recent years, there have been a number of reports of good results in the surgical treatment of ascending arch aortic lesions in advanced age. Currently, heart transplantation and ventricular assist device implantation are still contraindications in elderly patients. The main problems of ventricular assist device implantation in elderly patients are systemic inflammatory reactions, thromboembolism and bleeding. Heart transplantation requires immunosuppressive agents, which are prone to infections and other serious complications in elderly patients. In addition, the severe shortage of donors and the high cost of medical care are among the reasons for increased caution regarding heart transplantation and ventricular assist device implantation in advanced age. Surgical methods and techniques: median chest incision, complete split sternum, ascending aorta and vena cava cannulation to establish extracorporeal circulation, hemodilution, blocking the ascending aorta and hypothermic cardiac arrest are the traditional methods of cardiovascular surgery in advanced age, which have the advantages of good exposure and easy and accurate operation, but their disadvantages are heavy pain, trauma, easy to cause systemic inflammatory reaction, chest incision and neurological complications in advanced age patients, postoperative However, its disadvantages are heavy pain, high trauma, prone to systemic inflammatory reaction, chest incision and neurological complications in elderly patients, slow recovery and long hospital stay. In view of this, since the 1990s, minimally invasive techniques such as normothermic non-extracorporeal cardiac nonstop, small thoracic incisions, total thoracoscopic or robotic surgery, and hybrid techniques combining medical interventions and surgical procedures have received increasing attention in advanced age, especially in high-risk patients. Major early complications of cardiovascular surgery in elderly patients: The major difference in complications of cardiovascular surgery in elderly patients over 70 years of age compared to patients under 70 years of age is the incidence of stroke. Age is a high risk factor associated with stroke, with the incidence of stroke in those over 70 years of age being about 5% compared with only about 3% in those under 60 years of age, which may be explained by the progressive increase in ascending aortic atherosclerosis and calcification with age. Aortic cannulation and placement of aortic blocking forceps in extracorporeal circulation are the main causes of aortic injury and plaque dislodgement resulting in cerebral embolism. Therefore, it is now advocated that aortic cannulation in elderly patients should be preceded by routine ascending aortic exploration or ultrasound scan to avoid severe sclerosis and calcification, and femoral artery cannulation can also be considered to establish extracorporeal circulation. In elderly patients undergoing coronary artery bypass grafting, the use of non-extracorporeal circulation techniques, bilateral internal mammary arteries, composite vascular bridges, and vascular bridge proximal anastomosis assist devices may reduce neurological complications. Long-term survival and quality of life after cardiovascular surgery in elderly patients The long-term survival rate of cardiovascular surgery in elderly patients is satisfactory, with a 5-year survival rate of approximately 70% in those aged 70-79 years and around 60% in those aged 80 years or older; 10 years after surgery, the survival rate in those aged 80 years or older decreases sharply to less than 15%, which is consistent with the current natural human lifespan. Compared to preoperative survival patients generally have significantly reduced symptoms, improved cardiac function, and the vast majority have significantly improved psychological status with reduced rates of depression and anxiety. Predictors of death after cardiovascular surgery in advanced age Patients of advanced age are safe and feasible to undergo cardiovascular surgery without comorbidities and other high-risk factors, with good clinical outcomes. It is therefore important to identify risk factors that increase surgical mortality and complications. Numerous studies have shown that renal insufficiency, chronic obstructive pulmonary disease, valvular surgery, cerebrovascular disease, low left ventricular ejection fraction, secondary open heart hemostasis and poor general condition are the main risk factors for increased mortality.