Related Experiment Videos
[Isolated coronary bypass operation in the 9th decade of life]
A Mortasawi1, U Rosendahl, T Schröder
1Herzzentrum Lahr/Baden Hohbergweg 2 D-77933 Lahr.
Insights
Coronary artery bypass grafting in patients over eighty yields acceptable short- and long-term outcomes. Survival rates post-myocardial revascularization are comparable to the general 82-year-old population.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Outcomes Research
Context:
- Increasing age of cardiac surgery patients over three decades.
- Advances in operative and perioperative care for open-heart surgery.
- Growing population of elderly individuals requiring cardiac interventions.
Purpose:
- Investigate short- and long-term results of myocardial revascularization in patients aged 80-88.
- Identify predictors of in-hospital and late mortality after coronary artery bypass grafting (CABG).
- Evaluate long-term survival, freedom from angina, and quality of life post-CABG in octogenarians.
Summary:
- A study of 121 patients (median age 82) undergoing isolated CABG found 6.6% in-hospital mortality.
- Predictors of mortality included low ejection fraction, heart failure history, and IABP use.
- Long-term survival rates were comparable to the general 82-year-old population, with freedom from angina and acceptable quality of life.
Impact:
- Demonstrates that CABG is a viable option for selected octogenarians with ischemic heart disease.
- Provides evidence supporting the safety and efficacy of myocardial revascularization in the elderly.
- Highlights the importance of patient selection and risk factor management in this age group.
Abstract:
The average age of patients undergoing cardiac surgery has increased continuously during the last three decades due to a progressively increasing number of older people in the population and the advances in operative and perioperative treatment in open heart surgery. Consequently we have investigated the short- and long-term results of isolated myocardial revascularization in patients who are in their ninth decade of life. Between 1 January 1995 and 31 December 1998, 121 patients (51 women, 70 men, age 80 to 88 years, median: 82 years) underwent isolated coronary artery bypass grafting. As part of the revascularization, a unilateral internal mammary artery graft (IMA) was used in 87% of cases. The in-hospital mortality was 6.6%. Analysis of predictors of mortality unveiled the following factors: ejection fraction less than 50%; history of recent left ventricular failure; extent of coronary artery disease; perioperative use of an intraaortic balloon pump (IABP) and symptomatic pericardial effusion. Use of the IMA revealed no influence on in-hospital mortality. The median follow-up time was 20 months (range: 2-48 months). Survival rates after 1, 2, and 3 years were 93.1%, 87.3% and 73.7% for women and 86.9%, 82.5% and 65.1% for men. These survival rates were comparable with those of the entire 82 year old population. Predictors for late death were male gender, history of stroke, history of arterial embolism, and postoperative pulmonary failure resulting in mechanical ventilation. During the follow-up period myocardial infarcts were subsequently not observed. Freedom from angina after 1, 2 and 3 years was 90.1%, 82.6% and 78.1%, respectively. At an interval of 1 year after the operation 87.6% of patients had not been hospitalized as a result of cardiac disorders (2 years: 80.1%, 3 years: 73.2%). Permanent nursing care was not required 1 year after the operation by 94.3% of patients (2 years: 91.5%, 3 years: 91.5%). Four percent of the survivors suffered from permanent delirium, 3% from depression, 5% from lack of concentration, and 6% from vertigo. In summary this study has revealed that, in patients over eighty years of age suffering from ischemic heart disease, coronary artery bypass grafting has acceptable short- and long-term results. Yearly mortality rates during the first 3 years after the operation are comparable with the expected mortality rate in an age-matched population.