Coronary artery bypass surgery in old age group: is age itself a barrier?
Mudassir Iqbal Dar1, Asim Hassan Dar, Khalil Almani
1Liaquat National Hospital, Stadium Road, Karachi, Pakistan.
Insights
Coronary artery bypass graft (CABG) is feasible in selected elderly patients. Key risk factors for mortality include left main stem lesions, recent myocardial infarction, poor left ventricular function, prolonged cardiopulmonary bypass time, and postoperative stroke.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Surgical Outcomes Research
Background:
- Elderly patients (≥70 years) undergoing Coronary Artery Bypass Graft (CABG) surgery present unique challenges.
- Identifying preoperative and intraoperative risk factors is crucial for improving outcomes in this demographic.
Purpose of the Study:
- To retrospectively analyze data and identify risk factors associated with adverse mortality in patients aged 70 years and older undergoing CABG.
- To evaluate the safety and efficacy of CABG in a selected elderly population.
Main Methods:
- Retrospective analysis of 63 patients aged 70+ undergoing primary isolated CABG between January 2003 and October 2007.
- Data collected included patient demographics, preoperative conditions (NYHA class, LMS lesion, renal impairment, stroke history), intraoperative details (CPB time), and postoperative outcomes (mortality, ICU/ward stay).
- Statistical analysis identified independent predictors of operative mortality.
Main Results:
- Overall hospital mortality was 9.5%.
- Significant independent predictors of operative mortality included preoperative left main stem (LMS) lesion, myocardial infarction (MI) within 48 hours, poor left ventricular function, prolonged cardiopulmonary bypass (CPB) time, and postoperative stroke.
- Mean Parsonet scores differed significantly between patients who died (23±3) and those who survived (10±3).
Conclusions:
- CABG can be safely performed in carefully selected elderly patients.
- Attention to specific risk factors such as LMS disease, recent MI, ventricular dysfunction, CPB duration, and stroke is essential for reducing postoperative mortality.
- Advanced age alone may not be the primary determinant of mortality in this patient group.
Objective:
To analyse the data retrospectively and identify risk factors that may adversely affect mortality in patients aged seventy years and older with coronary artery bypass graft (CABG).
Methods:
From Jan 2003 to Oct 2007, 63 consecutive patients of 70 years or older underwent primary isolated CABG on cardiopulmonary bypass (CPB) in Department of Surgery, Liaquat National Hospital. Forty one (65%) were male. The mean age was 72.7 +/- 3 years (range 70 to 81 years). Preoperatively 83% were in New York Heart Association (NYHA) class III or IV. Left main stem (LMS) lesion (> 70%) was present in 20 (32%). Renal impairment (RI) with creatinine more then 2 mg/dl was present in 9 (14%) patients. History of prior stroke was present in 7 (11%). Emergency surgery (within 48 hours after Myocardial Infarct (MI)) was performed in 33 (52%) patients.
Results:
The overall hospital mortality (30 days) was 9.5%. The mean Parsonet score was 23 +/- 3, and 10 +/- 3 in those who died or survived respectively. Mean intensive care unit stay was 2.3 +/- 0.7 days, mean ward stay was 6 +/- 3 days. Preoperative LMS lesion or MI less then 48 hours, poor left ventriculal function, prolonged CPB time and post operative stroke were the significant independent predictors of operative morality.
Conclusion:
CABG can be performed in a selected elderly population. Careful attention to risk factors associated with high mortality can be helpful in improving post-operative morality. Age in itself may not be responsible for high morality.
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