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Impaired left ventricular function as a predictive factor for mid-term survival in octogenarians after primary
Denis Berdajs1, Sotirios Marinakis, Ulf Kessler
1Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. denis.berdajs@chuv.ch
Insights
Coronary artery bypass grafting (CABG) in octogenarians with reduced ejection fraction (EF) shows acceptable short-term survival. Impaired EF does not significantly increase mortality risk in this elderly population undergoing CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Preoperative left ventricular ejection fraction (EF) is a critical factor in cardiac surgery outcomes.
- Octogenarians represent a growing population undergoing complex cardiac procedures like coronary artery bypass grafting (CABG).
- The impact of impaired EF on short-term survival in octogenarian CABG patients requires detailed evaluation.
Purpose of the Study:
- To evaluate the impact of preoperative impaired left ventricular ejection fraction (EF) on short-term survival in octogenarians undergoing coronary artery bypass grafting (CABG).
- To compare mortality rates across different EF strata in this elderly cohort.
- To identify predictive factors for in-hospital and short-term mortality following CABG in octogenarians.
Main Methods:
- A cohort of 147 octogenarians (mean age 82.1 years) with coronary artery disease underwent elective CABG.
- Patients were stratified into three groups based on preoperative EF: >50% (Group I), 30-50% (Group II), and <30% (Group III).
- In-hospital and short-term follow-up mortality were assessed, along with independent predictive factors.
Main Results:
- No significant differences in comorbidities (COPD, renal failure, CHF, diabetes, cerebrovascular events) were observed among the EF groups.
- Postoperative atrial fibrillation was the sole independent predictor of in-hospital mortality (OR, 18.1).
- Independent predictors for mortality during follow-up included a decrease in EF >5% (OR, 5.2), use of left internal mammary artery as a free graft (OR, 18.1), and follow-up EF <40% (OR, 4.8).
Conclusions:
- Coronary artery bypass grafting (CABG) in octogenarians with impaired ejection fraction (EF) demonstrates acceptable in-hospital and short-term mortality rates.
- These outcomes are comparable to or better than reported mortality rates in younger patient populations.
- CABG is a viable and safe treatment option for octogenarians with impaired EF, offering acceptable survival benefits.
Background:
The impact of preoperative impaired left ventricular ejection fraction (EF) in octogenarians following coronary bypass surgery on short-term survival was evaluated in this study.
Methods:
A total of 147 octogenarians (mean age 82.1 ± 1.9 years) with coronary artery diseases underwent elective coronary artery bypass graft between January 2000 and December 2009. Patients were stratified into: Group I (n = 59) with EF >50%, Group II (n = 59) with 50% > EF >30% and in Group III (n = 29) with 30% > EF.
Results:
There was no difference among the three groups regarding incidence of COPD, renal failure, congestive heart failure, diabetes, and preoperative cerebrovascular events. Postoperative atrial fibrillation was the sole independent predictive factor for in-hospital mortality (odds ratio (OR), 18.1); this was 8.5% in Group I, 15.3% in Group II and 10.3% in Group III. Independent predictive factors for mortality during follow up were: decrease of EF during follow-up for more that 5% (OR, 5.2), usage of left internal mammary artery as free graft (OR, 18.1), and EF in follow-up lower than 40% (OR, 4.8).
Conclusions:
The results herein suggest acceptable in-hospital as well short-term mortality in octogenarians with impaired EF following coronary artery bypass grafting (CABG) and are comparable to recent literature where the mortality of younger patients was up to 15% and short-term mortality up to 40%, respectively. Accordingly, we can also state that in an octogenarian cohort with impaired EF, CABG is a viable treatment with acceptable mortality.
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