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Coronary artery bypass in patients 80 years and older: comparison with a younger age group
Hiroyuki Tanaka1, Takashi Narisawa, Mikio Masuda
1Department of Thoracic Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
Insights
Octogenarians undergoing coronary artery bypass grafting (CABG) experienced acceptable outcomes. Off-pump CABG in elderly patients showed reduced mortality and morbidity compared to younger groups.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Anesthesiology
Background:
- Elderly patients (≥80 years) face higher risks for complications after coronary artery bypass grafting (CABG).
- Comparing outcomes in octogenarians versus younger elderly patients is crucial for surgical decision-making.
Purpose of the Study:
- To compare perioperative outcomes of coronary artery bypass grafting (CABG) in octogenarians versus patients aged 70-79 years.
- To evaluate the safety and efficacy of off-pump CABG in octogenarian patients.
Main Methods:
- Retrospective comparison of perioperative outcomes for CABG patients aged ≥80 years (n=15) and 70-79 years (n=64) from March 1997 to June 2003.
- Analysis included comorbidities, surgical approach (on-pump vs. off-pump), revascularization completeness, and postoperative complications.
Main Results:
- Octogenarians had higher rates of congestive heart failure (40% vs. 9%) and underwent off-pump CABG more frequently (80% vs. 42%).
- No significant differences in emergent surgery or graft numbers were observed.
- Octogenarians experienced more minor wound complications (20% vs. 3%) but had no operative deaths, unlike the younger group (6% mortality).
Conclusions:
- Off-pump CABG can be performed in octogenarians with acceptable perioperative mortality and morbidity.
- Surgical myocardial revascularization is feasible in octogenarians, with careful consideration of comorbidities and surgical technique.
Abstract:
Octogenarians are at increased risk for perioperative morbidity and mortality following coronary artery bypass grafting (CABG). We compared the perioperative outcome after CABG from March 1997 to June 2003, between patients 80 years and older (n=15), and those aged 70 to 79 years (n=64). In comparison with younger patients, more octogenarians had congestive heart failure (40% vs. 9% in patients aged 70 to 79 years, p=0.003) and underwent off-pump CABG more frequently (80% vs. 42%, p=0.008). There were no significant differences in the incidence of emergent surgery (27% vs. 28%) and number of bypass grafts (2.3+/-0.7 vs. 2.5+/-0.9) between the two groups. Octogenarians had less complete revascularization compared to the younger group (67% vs. 81%, not significant). There was no mediastinitis, and no stroke in either groups. Octogenarians had more minor wound complications (20% vs. 3%, p=0.01). There were no operative deaths in octogenarians, while the mortality rate of the younger group was high (6%). Surgical myocardial revascularization in octogenarians can be performed with acceptable mortality and morbidity using off-pump CABG.
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