Priority 12 from the Heart Surgery PSP

UNCERTAINTY: What are the benefits of heart surgery in older patients? (JLA PSP Priority 12)
Overall ranking 12
JLA question ID 0088/12
Explanatory note Most guidelines comment on the surgical risk in older patients, mostly exploring the concept of frailty and comparing cardiac surgery with interventional alternatives, and several high quality systematic reviews assess the efficacy of strategies targeted to optimize the treatment in older patient. Moreover, careful patients selection and preoperative assessment in geriatric patients has been investigated across various surgical disciplines along with rehabilitation strategies targeted to the patient’s age.
Nonetheless, the issue examined is broad enough to require further and more specific research and the increasing age of cardiac surgical population makes it even more relevant.
~ What are the benefits of heart surgery in eldery patients? What is the inflammatory and haematological response to heart surgery in older patients and is it different to younger patients?
Evidence

Eamer G, Taheri A, Chen SS, Daviduck Q, Chambers T, Shi X, et al. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database of Systematic Reviews. 2018(1).; Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2019;55(1):4-90.; Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg. 2017;52(4):616-64. 
Health Research Classification System category Cardiovascular
Extra information provided by this PSP
Original uncertainty examples What are the benefits of heart surgery in older (>80) patients? ~ Is there a socioeconomic benefit to operating on patients ≥75 years old. Are we improving quality of life? ~ What is the impact of cardiac surgery on quality of life and life expectancy in elderly patients?  
Submitted by 1 x patient; 16 x healthcare professional 
PSP information
PSP unique ID 0088
PSP name Heart Surgery
Total number of uncertainties identified by this PSP. 45  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 11 July 2019