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Cardiopulmonary bypass and left ventricular systolic dysfunction impacts operative mortality differently in elderly
Dumbor L Ngaage1, Michael E Cowen, Alexander R Cale
1Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire, United Kingdom.
Insights
Elderly patients undergoing cardiac surgery face higher risks, with age and cardiopulmonary bypass (CPB) time significantly increasing operative mortality. Moderate left ventricular systolic dysfunction (LVSD) impacts younger patients more than older ones.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Cardiac surgery poses higher risks for elderly patients.
- Preoperative left ventricular systolic dysfunction (LVSD) and cardiopulmonary bypass (CPB) may affect elderly and young patients differently.
- Investigating these differences is crucial for risk stratification.
Purpose of the Study:
- To investigate the predictive risk of preoperative LVSD and CPB time for operative mortality in elderly versus young cardiac surgery patients.
- To identify specific risk factors contributing to higher mortality rates in the elderly.
Main Methods:
- Retrospective review of 2616 elderly (>70 years) and 4078 young patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery.
- Analysis of subgroups based on LVSD severity (mild, moderate, severe).
- Logistic regression models used to identify risk factors.
Main Results:
- Elderly patients had higher operative mortality, particularly with moderate and severe LVSD.
- Age and CPB time were significant predictors of mortality in the elderly, but not in younger patients.
- Moderate LVSD was a risk factor for young patients, but not for the elderly.
Conclusions:
- Disparities in risk factor significance contribute to higher operative mortality in elderly patients.
- Age and CPB duration are key risk factors for elderly patients; moderate LVSD's impact is less pronounced in this group.
- Further research is needed on biocompatible bypass systems and revised risk stratification for elderly patients.
Objective:
Cardiac surgery is higher risk in the elderly. It has been suggested that preoperative left ventricular systolic dysfunction (LVSD) and cardiopulmonary bypass (CPB) affect elderly and young patients differently. This study investigates the predictive risk of preoperative LVSD and CPB time for operative mortality in the two groups of patients.
Methods:
We reviewed the data for 2616 consecutive patients aged >/=70 years and 4078 young patients who had coronary artery bypass grafting (CABG) and/or valve surgery between March 1998 and January 2007. Subgroups defined by severity of LVSD (ejection fraction >0.50 [mild], 0.31-0.50 [moderate] and
Results:
Elderly patients were higher risk and more often underwent valve operation. Moderate and severe LVSD were present in 22% (n=566) and 6% (n=155) of elderly compared to 18% (n=739) and 5% (n=215) of young patients (p=0.001). Operative mortality for CABG was higher in elderly patients with mild (2.3% vs 0.7%, p<0.0001), moderate (4.7% vs 2.3%, p=0.04) and severe LVSD (13.5% vs 8.8%, p=0.01). Although CPB times for similar procedures were equivalent for the two groups, procedure-specific mortality rates were higher among elderly patients for all operations. Whereas age (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.03-1.15, p=0.002) and CPB time (OR 1.01, 95% CI 1.0-1.02, p<0.0001) were predictors for operative mortality for the elderly, they (age [OR 1.0, 95% CI 0.96-1.05, p=0.87], CPB time [OR 1.0, 95% CI 1.0-1.01, p=0.17]) were not for young patients. Moderate LVSD was a risk factor for young patients (OR 3.01, 95% CI 1.45-6.26, p=0.003) but not for the elderly (OR 1.33, 95% CI 0.77-2.29, p=0.30).
Conclusion:
Differences in the significance of risk factors between elderly and young patients contribute to the disproportionate operative mortalities. Our data showed that age and CPB duration increased the risk of operative mortality only in the elderly, but the impact of moderate, unlike severe, LVSD was tempered. Further studies are warranted to investigate more biocompatible bypass systems in elderly patients, and if current risk stratification should, perhaps, be revised for elderly patients.
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