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Coronary artery bypass surgery in octogenarians: outcomes in a tertiary referral university hospital in a developing
Habib A Dakik1, Hwaida Hannoush, Mounir Y Obeid
1Division of Cardiology, American University of Beirut-Medical Center, PO Box 11-0236/A38, Beirut, Lebanon. hd01@aub.edu.lb
Insights
Coronary artery bypass grafting (CABG) in octogenarians is safe in developing countries, showing 0% in-hospital mortality. Careful patient selection is key for successful outcomes in this elderly population undergoing cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Outcomes Research
Background:
- Increasing global population of individuals over 80 years old.
- Growing referral rates for coronary artery bypass surgery (CABG) in octogenarians.
- Limited data on CABG outcomes in octogenarians from developing countries.
Purpose of the Study:
- To analyze clinical characteristics of octogenarian patients undergoing CABG.
- To evaluate in-hospital events in this patient cohort.
- To assess the feasibility and safety of CABG in a developing country context.
Main Methods:
- Retrospective review of 28 consecutive octogenarian patients undergoing CABG.
- Data collected: demographics, clinical findings, operative details, and in-hospital events (death, myocardial infarction, stroke).
- Study period: January 1998 to December 2000 at a tertiary referral university hospital.
Main Results:
- Mean age 82 years; 75% male. 78% presented with acute myocardial infarction or unstable angina.
- 0% in-hospital mortality; 11% post-operative myocardial infarction; 4% stroke.
- Concomitant aortic valve replacement and ejection fraction <40% predicted adverse events.
Conclusions:
- CABG in carefully selected, clinically stable octogenarians (NYHA class I/II) is associated with acceptable risk.
- Low in-hospital mortality is achievable in this demographic, even in developing countries.
- Non-emergent CABG procedures in this cohort demonstrate favorable outcomes.
Background:
The number of people older than 80 years is increasing worldwide and many of these patients are being referred for coronary artery bypass surgery (CABG). Several recent reports from the USA and Europe have shown that CABG can be performed in octogenarians with an acceptable risk. However, data from developing countries regarding this subject is lacking. The objective of this study was to analyze the clinical characteristics and in-hospital events of octogenarian patients undergoing CABG at a tertiary referral university hospital in a developing country.
Methods:
The study included 28 consecutive octogenarian patients who underwent CABG at the American University of Beirut, between January 1998 and December 2000. The medical records of these patients were reviewed for demographic information, clinical and catheterization findings, operative characteristics, and in-hospital events (death, myocardial infarction, and stroke).
Results:
The mean age of the study group was 82 +/- 2 years and 75% were males. Seventy-eight percent of the patients had an acute myocardial infarction or unstable angina prior to CABG. All of the patients were in NYHA class I or II and none of the operations were done on an emergent basis. The mean ejection fraction was 48 +/- 7%. Eighty-six percent of patients had multivessel disease and four patients had aortic valve replacement (AVR) concomitantly with the CABG. The in-hospital mortality was 0%. Three patients (11%) had a post-operative myocardial infarction, and one patient (4%) had a stroke. The mean post-operative stay was 9 +/- 7 days with only three patients (11%) staying for more than 14 days. The multivariate predictors of in-hospital cardiovascular events were concomitant AVR (P=0.01), and an ejection fraction <40% (P=0.03).
Conclusion:
In carefully selected octogenarian patients who are clinically stable in NYHA class I or II, and where the operation is not done on an emergent basis, CABG can be performed with an acceptable risk and a low in-hospital mortality.
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