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Coronary artery bypass surgery in the elderly
A B McIntyre1, J F Ballenger, A T King
1Heart Center, Richland Memorial Hospital, Columbia, S.C.
Insights
Coronary artery bypass grafting (CABG) surgery in elderly patients (≥70 years) demonstrates acceptable operative mortality and good survival. While CNS morbidity is a concern, CABG improves quality of life for carefully selected elderly individuals with severe coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Cardiac Surgery Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a significant intervention for severe coronary artery disease.
- The safety and efficacy of CABG in elderly populations (≥70 years) require careful consideration due to potential comorbidities and altered physiological reserve.
Purpose of the Study:
- To evaluate the outcomes of CABG in elderly patients (≥70 years) undergoing the procedure.
- To assess operative mortality, long-term survival, and postoperative morbidity in this demographic.
Main Methods:
- Retrospective review of 250 consecutive patients aged 70 years or greater who underwent CABG.
- Analysis of operative mortality, short-term and long-term survival rates.
- Documentation of postoperative central nervous system (CNS) morbidity.
Main Results:
- An acceptable operative mortality rate of 3.6% was observed in the elderly cohort.
- Good short-term and long-term survival rates were documented.
- A modest but significant elevation in postoperative CNS morbidity was noted, warranting attention.
Conclusions:
- CABG can be safely offered to carefully selected elderly patients with severe coronary artery disease, including those with intractable angina, heart failure, or significant multi-vessel/left main disease.
- Thorough preoperative evaluation, including assessment of family support, and open communication are crucial for decision-making.
- The benefits of improved lifestyle and enhanced survival justify CABG in eligible elderly patients.
Abstract:
In order to place the issue of CABG surgery in the elderly in a personal perspective, we have reviewed our series of 250 consecutive patients 70 years or greater in age at the time of surgery and have noted a very acceptable (3.6%) operative mortality. Good short and long term survival has been documented. A modest but important elevation of postoperative CNS morbidity has been documented and remains of concern. We have continued to offer CABG to those patients with acceptable risks who have either intractable angina, intractable ischemic heart failure and multi-vessel disease. Left main obstruction of a significant degree or those with threatening three vessel anatomy in association with a sentinel ischemic event are candidates for the CABG procedure. Substantial preoperative evaluation to include the family support substrate must be an important part of the decision process as well as open communication with concerned family members. We feel that the improved life style and enhanced survival justifies CABG in those elderly patients identified with severe coronary artery disease.