[Coronary surgery after 70 years of age]

Previous reports on coronary artery bypass grafting in elderly patients have not usually addressed the current era of aggressive percutaneous angioplasty. To investigate this important subgroup of patients, we analyzed our recent coronary artery bypass grafting experience with patients 70 years of age or older from May 1988 to August 1993, 158 consecutive patients in this age range (mean age 70.3 years) underwent surgical revascularization at our institution. Overall operative mortality was 4.4% (7/158), with 71.4% (5/7) of deaths due to cardiac causes. Postoperative morbidity occurred in 50.6% (80/158) of patients but was of a serious nature in only 12.0% (19/158). Surgical priority was significantly correlated with operative mortality: 1.6% (2/122) for elective cases and 17.2% (5/29) for urgent or emergency cases (p < 0.01). Univariate analysis isolated the need for postoperative inotropic support or mechanical assistance, perioperative myocardial infarction and reoperation for bleeding as significant risk factors for operative mortality (p < 0.01). Of the patients discharged from the hospital, 144 (95.4%) were followed up for a mean of 23 months (3-62). During the follow-up period there were 3 deaths, all from non cardiac causes, and 92.3% of the patients were in Canadian Cardiovascular Society class I (CCS). These results indicate that, although with somewhat higher morbidity and mortality rates, elderly patients have a very acceptable operative risk in the current era of high-risk coronary artery bypass grafting, particularly if elective revascularization is possible.