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Predictors of perioperative mortality after coronary artery bypass grafting in the elderly
1Department of Cardiothoracic Surgery, Vienna General Hospital, University of Vienna, Vienna, Austria. juliane.kilo@akh-wien.ac.at
Insights
Coronary artery bypass grafting (CABG) in elderly patients carries significant risk. Avoiding cardiopulmonary bypass (CPB) can reduce mortality and morbidity in this population.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) presents elevated operative risks for elderly patients compared to younger individuals.
- Identifying specific risk factors for perioperative mortality in this demographic is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the independent risk factors associated with perioperative mortality in elderly patients undergoing isolated CABG.
- To determine if the use of cardiopulmonary bypass (CPB) impacts mortality rates in this patient group.
Main Methods:
- A cohort of 325 patients aged 75 and above undergoing isolated CABG was analyzed.
- Patient characteristics, perioperative outcomes, and complications were compared between survivors and non-survivors.
- Multivariate logistic regression analysis identified independent predictors of perioperative mortality.
Main Results:
- Non-survivors more frequently presented with extracardiac atherosclerosis and preoperative renal insufficiency.
- A trend towards higher incidences of impaired left ventricular function and recent myocardial infarction was observed in non-survivors.
- Multivariate analysis identified impaired renal function, use of cardiopulmonary bypass (CPB), extracardiac atherosclerosis, and recent myocardial infarction as independent risk factors for mortality.
Conclusions:
- Impaired renal function, extracardiac atherosclerosis, recent myocardial infarction, and the use of CPB are significant risk factors for perioperative mortality in elderly CABG patients.
- Avoiding CPB during CABG in the elderly may lead to substantial reductions in perioperative mortality and morbidity.
Background:
Coronary artery bypass grafting (CABG) is associated with higher operative risk in the elderly compared to younger patients. The aim of this study was to evaluate risk factors for perioperative mortality after CABG in the elderly.
Methods:
We investigated 325 consecutive patients aged 75 or over undergoing isolated CABG at our institution. We analyzed the patients' characteristics and perioperative outcome. Patients were divided into survivors and non-survivors; risk factors and complications were compared. Based on this, we performed a multivariate logistic regression analysis to determine independent risk factors for perioperative mortality.
Results:
Non-survivors of CABG more often suffered from concomitant extracardiac atherosclerosis (non-survivors, 62.2 %; survivors, 40.6 %; p = 0.013) as well as from renal insufficiency preoperatively (non-survivors, 35.1 %; survivors 8.0 %; p < 0.0001). A trend towards higher incidences of impaired left ventricular function (non-survivors, 37.8 %; survivors, 29.9 %; p = 0.105) and a history of recent myocardial infarction (non-survivors, 29.7 %; survivors, 17.0 %; p = 0.061) were found in non-survivors compared to survivors. Furthermore, non-survivors more often underwent CABG with cardiopulmonary bypass (CPB non-survivors, 96.1 %; survivors 70.6 %; p = 0.0005). Multivariate logistic regression analysis revealed that preoperatively impaired renal function (OR: 2.857, p < 0.0001), use of CPB (OR: 5.952, p = 0.0175), extracardiac atherosclerosis (OR: 1.581, p = 0.0228), and recent myocardial infarction (OR: 1.574, p = 0.0405) were independent risk factors for perioperative mortality. Comparison of patients undergoing CABG with or without CPB reveals that patients operated without CPB had a higher preoperative risk than patients undergoing CABG with CPB.
Conclusion:
These results show that besides impaired renal function, extracardiac atherosclerosis, and history of recent myocardial infarction, the use of CPB is a major risk factor for CABG in the elderly. Perioperative mortality and morbidity can be significantly reduced if CPB is avoided.
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