Coronary artery bypass grafting in the elderly

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Clinical Outcomes Research

Background:

• Increasing incidence of coronary artery bypass grafting (CABG) in elderly populations.
• Need to evaluate surgical outcomes and long-term prognosis in older patients undergoing CABG.

Purpose of the Study:

• To compare the outcomes of CABG in patients aged 75 years and older with those in younger patients.
• To assess perioperative risks, postoperative course, and long-term survival and cardiac event-free rates.

Main Methods:

• Retrospective analysis of CABG patients at Shin-Tokyo Hospital (1991-1998).
• Comparison of elderly (>=75 years, n=190) and younger (<75 years, n=1,380) patient groups.
• Collection and analysis of preoperative, perioperative, and follow-up data.

Main Results:

• Elderly group (Group E) had higher rates of female gender, emergent CABG, preoperative balloon pumping, cardiogenic shock, hypertension, and prior stroke.
• Group E showed less use of bilateral internal mammary artery, more use of saphenous vein, and higher blood transfusion rates.
• Postoperative course in Group E involved longer intubation, ICU stay, hospital stay, and higher rates of major complications and in-hospital death.
• Actuarial 5-year survival (excluding in-hospital mortality) was lower in Group E (84.3%) compared to Group Y (92.5%).
• Actuarial 5-year cardiac event-free rates were similar: 79.9% in Group E vs. 79.7% in Group Y.

Conclusions:

• CABG in elderly patients is associated with increased surgical risks and mortality.
• Despite risks, long-term cardiac event-free rates after CABG are comparable between elderly and younger patients.
• Inferior long-term survival in the elderly is likely attributable to the aging process itself.