This retrospective study analyzes the perioperative and long-term survival rate as well as the long-term quality of life of 54 patients (23 f/31 m), aged 80 years or older (80 to 87, mean 82.2, SD +/- 1.79 years), who underwent open heart surgery between January 1986 and December 1993. There were 23 patients with coronary bypass, 21 with aortic valve replacement, 1 with mitral valve replacement, 8 with combined aortic valve replacement and coronary bypass, and 1 with double valve replacement. Preoperatively, 26 of the patients were in New York Heart Association (NYHA) class IV, 28 patients in class III. The in-hospital mortality was 9.3% (5/54) over all and 6.1% (3/49) for elective procedures. Follow-up time ranged from 6 to 91 months (mean 26.2 +/- 16.5). Of 49 discharged patients, 6 (12.2%) died during the follow-up period. At the time of re-evaluation 21 patients were in NYHA class I, 24 patients in class II, and 4 in class III. There was a significant long-term benefit from the surgical intervention in 39 or the 54 patients. Of 43 survivors 41 were able to live on their own and 38 were able to handle their daily routine without help. Two patients were cared for in a nursing home. This long-term analysis demonstrates the benefits of cardiovascular surgery in octogenarians in terms of social integration and quality of life.