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Published on: March 27, 2018
Do octogenarians benefit from coronary artery bypass surgery: a question with a rapidly changing answer?
1Florida Heart Research Institute, Miami, Florida, USA. doctorwu18@aol.com
Insights
Coronary artery bypass graft (CABG) surgery in octogenarians shows improved long-term survival and quality of life. This high-risk group benefits from careful patient selection and a collaborative Heart Team approach for optimal outcomes.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Public Health
Background:
- Octogenarians are the fastest-growing population segment.
- Over 40% of octogenarians have cardiovascular disease, often advanced and requiring surgical revascularization.
- This demographic presents significant healthcare challenges due to increased mortality, morbidity, and costs.
Purpose of the Study:
- To review the outcomes of coronary artery bypass graft (CABG) surgery in octogenarians.
- To assess the long-term survival and quality of life in this elderly cohort.
- To compare CABG with alternative therapies and inform treatment decisions.
Main Methods:
- Review of outcomes for octogenarian patients undergoing CABG surgery.
- Analysis of long-term survival and quality of life data.
- Comparison of CABG with alternative treatment modalities.
Main Results:
- CABG surgery in octogenarians demonstrates consistent improvement over time.
- Long-term survival and quality of life outcomes rival those of the age-matched general population.
- CABG appears favorable when compared to alternative therapies, with evolving cost-effectiveness.
Conclusions:
- CABG surgery in octogenarians can be performed with increasingly positive results.
- Future research should focus on optimal surgical strategies and patient selection for this cohort.
- The collaborative 'Heart Team' approach, frailty management, and economic modeling are crucial for guiding clinical and policy decisions.
Purpose Of Review:
Octogenarians represent the fastest-growing segment of the population. Over 40% manifest cardiovascular disease, frequently in an advanced state requiring surgical revascularization. Increased mortality, morbidity, and expense in this high-risk group, with decreased longevity, present a growing challenge to our healthcare system.
Recent Findings:
Results of coronary artery bypass graft (CABG) surgery in octogenarians show a consistent pattern of improvement over time, with documented long-term survival and quality of life that rivals the age-matched population. Comparison with alternative therapies appears to be favorable. Clearer understanding of costs will provide a more rational context for treatment decisions. Increasing interest in the specific issues regarding frailty will help to guide the most appropriate patient selection.
Summary:
Although it is clear that CABG surgery in octogenarians can be accomplished with increasingly good results, future research will need to focus on what specific surgical strategies are most appropriate for this elderly cohort; how the collaborative 'Heart Team' approach can be most effectively applied to determination of the most appropriate therapeutic course for these complex, frequently high-risk patients; what strategies can be applied to best manage and possibly reverse patient frailty; and what economic models most meaningfully inform clinical and public policy decision-making.
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