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Risk factors and outcomes after coronary reoperation in 739 elderly patients
M Yamamuro1, B W Lytle, S K Sapp
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
The Annals of Thoracic Surgery
|March 29, 2000
Summary
Second coronary artery bypass graft (CABG) reoperations in patients 70 and older show good outcomes, but specific risk factors increase mortality. Identifying these factors aids patient decision-making for reoperation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Second coronary artery bypass graft (CABG) operations are increasingly performed in elderly individuals.
- A retrospective analysis was conducted to evaluate outcomes in patients aged 70 and over undergoing repeat CABG.
Purpose of the Study:
- To identify risk factors associated with in-hospital and late mortality after a second CABG in elderly patients (aged 70+).
- To provide data to assist in patient counseling regarding reoperation decisions.
Main Methods:
- Reviewed records of 739 patients aged 70 or older who underwent second CABG between 1983 and 1993.
- Analyzed preoperative, operative, and postoperative variables to determine predictors of mortality.
Main Results:
- In-hospital mortality was 7.6%. Predictors included elevated creatinine, emergency operation, female sex, left ventricular dysfunction, and left main coronary disease.
- Long-term survival was 75% at 5 years and 49% at 10 years. Cardiac event-free survival was 60% at 5 years and 27% at 10 years.
- Late mortality was associated with lower hematocrit, diabetes, peripheral vascular disease, impaired left ventricular function, cancer history, nonsinus rhythm, specific therapies, and postoperative complications like encephalopathy or stroke.
Conclusions:
- Repeat CABG in elderly patients can yield excellent results.
- Specific risk factors and comorbidities significantly increase mortality risk in this population.
- Understanding these factors is crucial for informed patient consent and decision-making regarding reoperation.