OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations in-volving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in seni-or-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicen-ter registry study in mainland China.Multiple variable regression analysis was performed in patients over 75 years old to identi-fy risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(＞75 years)patients were enrolled in China HFSR,21.1％of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6％of patients,10.1％of patients underwent isolated valve sur-gery and 8.7％received CABG combined with valve surgery.In-hospital mortality was 10.6％,and the major complication rate was 17.3％.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class Ⅲ(OR=1.408),NYHA class Ⅳ(OR=1.955),cardiogenic shock(OR,6.271),and preoper-ative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of re-versible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more fre-quent comorbidities,which may lead to a high risk in mortality.