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Beating heart surgery in octogenarians: perioperative outcome and comparison with younger age groups
S C Stamou1, G Dangas, M K Dullum
1Department of Surgery, Washington Hospital Center, Washington, DC 20010, USA.
Insights
Off-pump coronary artery bypass grafting in octogenarians shows acceptable outcomes. This surgical approach for patients over 80 years old results in manageable morbidity, mortality, and hospital stays, offering a viable option for this age group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Surgical Outcomes
Background:
- Octogenarians face higher risks (9-16%) of morbidity and mortality following traditional coronary artery bypass grafting (CABG) with cardiopulmonary bypass.
- This highlights a critical need for safer surgical alternatives in elderly cardiac patients.
Purpose of the Study:
- To compare perioperative outcomes and hospital stay for off-pump coronary artery bypass grafting (OPCABG) in octogenarians versus younger patient groups.
- To evaluate the safety and efficacy of OPCABG in patients aged 80 years and older.
Main Methods:
- A comparative study analyzed perioperative outcomes and hospital stay for OPCABG from 1987 to 1999.
- Patient groups included octogenarians (>80 years), 70-79 year-olds, and 60-69 year-olds.
- Demographic and clinical data, including urgency of surgery and previous myocardial infarction, were compared.
Main Results:
- Octogenarians had higher rates of pneumonia (6%) and atrial fibrillation (47%) compared to younger groups.
- Age over 80 was an independent predictor of prolonged hospital stay (OR=2.7).
- In-hospital mortality was higher in octogenarians (6%) versus 3% (70-79) and 0.3% (60-69).
Conclusions:
- Off-pump coronary artery bypass grafting can be performed in octogenarians with acceptable postoperative morbidity, mortality, and hospital stay.
- OPCABG represents a potentially safer surgical strategy for elderly patients requiring coronary artery bypass surgery.
Background:
Octogenarians have higher morbidity and mortality rates (9% to 16%) after coronary artery bypass grafting with cardiopulmonary bypass, compared with younger patients.
Methods:
We compared the perioperative outcome and hospital stay after coronary artery bypass grafting without cardiopulmonary bypass (off-pump) from January 1987 to May 1999, among patients older than 80 years (n = 71), patients between 70 and 79 years (n = 228), and patients whose age ranged from 60 to 69 years (n = 296). In comparison with younger patients, more octogenarians were female (51% versus 39% in patients aged 70 to 79 years and 35% in those aged 60 to 69 years, p = 0.04), they had previous myocardial infarction more frequently (48% versus 47% versus 34%, respectively, p = 0.008), and were operated on urgently (69% versus 56% versus 52%, respectively, p = 0.04).
Results:
Postoperative complications that were significantly higher in octogenarians compared with younger groups included pneumonia (6% in octogenarians versus 2% in patients aged 70 to 79 years and 0% in patients aged 60 to 69 years, p = 0.001) and atrial fibrillation (47% versus 32% versus 21%, respectively, p<0.001). By multivariate logistic regression analysis, age over 80 years was an independent predictor of prolonged hospital stay (odds ratio = 2.7, 95% confidence interval, 1.4 to 5, p<0.001). The in-hospital mortality rate was higher in octogenarians (6% versus 3% for 70 to 79 year-olds and 0.3% for 60 to 69 year-olds, p = 0.006).
Conclusions:
When appropriately applied in patients older than 80 years, off-pump coronary artery bypass grafting can be done with acceptable postoperative morbidity, mortality, and hospital stay.