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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
09:12

Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery

Published on: March 27, 2018

Identification of very high risk octogenarians undergoing coronary artery bypass surgery: results of a multicenter

Stefano Rosato1, Fausto Biancari, Alice Maraschini

  • 1National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Via Giano della Bella, 34, 00161, Rome, Italy, stefano.rosato@iss.it.

Heart and Vessels
|October 24, 2012
PubMed

Insights

Elderly patients (≥80 years) undergoing coronary artery bypass grafting (CABG) face high operative risks. Emergency surgery, unstable hemodynamics, and low ejection fraction independently predict 30-day mortality in this population.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Coronary artery bypass grafting (CABG) in patients aged 80 years and older is associated with excellent long-term survival but carries a significant risk of immediate postoperative mortality.
  • Identifying factors contributing to very high operative risk in this specific, fragile patient demographic is crucial for improving outcomes.

Purpose of the Study:

  • To identify independent predictors of 30-day mortality in patients aged 80 years and older undergoing isolated CABG.
  • To analyze institutional variations in the proportion and operative risk of elderly patients undergoing CABG.

Main Methods:

  • A multicenter study involving 2,246 patients aged ≥80 years who underwent isolated CABG across 68 Italian hospitals.
  • Logistic regression and Classification and Regression Tree (CART) analysis were employed to identify independent predictors of 30-day mortality.
  • Analysis of institutional variations in patient demographics and operative risk scores (logistic EuroSCORE).

Main Results:

  • The overall 30-day mortality rate for patients aged ≥80 years was 6.5%.
  • Independent predictors of 30-day mortality included emergency procedure, low left ventricular ejection fraction, unstable hemodynamics, and use of nitrates infusion upon arrival.
  • CART analysis revealed a 32.60% 30-day mortality for emergency CABG with unstable hemodynamics and 20.0% for non-emergency cases with nitrates and LVEF <30%.

Conclusions:

  • The proportion of elderly patients undergoing CABG and their associated operative risks vary significantly among institutions.
  • Emergency surgery, unstable hemodynamics, nitrates use, and low ejection fraction identify a subset of elderly patients with prohibitive operative risk.
  • Percutaneous coronary intervention may be a beneficial alternative for this high-risk subgroup to stabilize preoperative conditions.

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