Related Experiment Videos
The characteristics of coronary artery revascularization in aged patients
M Sunamori1, J Amano, T Okamura
1Department of Thoracic-Cardiovascular Surgery, Tokyo Medical and Dental University, School of Medicine, Japan.
Insights
Coronary artery bypass grafting (CABG) is safe and effective for patients over 65, showing low operative mortality and excellent long-term survival. Careful management of postoperative complications is crucial for elderly individuals undergoing CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease.
- Assessing the safety and efficacy of CABG in elderly populations is crucial due to physiological changes associated with aging.
Purpose of the Study:
- To evaluate the clinical characteristics and surgical outcomes of coronary artery bypass grafting (CABG) in patients aged 65 and older.
- To compare mortality, morbidity, and late survival rates of elderly patients undergoing CABG with younger patient cohorts.
Main Methods:
- A comparative study involving three groups: 50-59 years (Group I), 60-64 years (Group II), and over 65 years (Group III).
- Coronary artery bypass grafting (CABG) was performed using saphenous vein grafts with cold K-Mg-cardioplegia and systemic hypothermia.
- Outcomes assessed included hospital mortality, operative mortality, morbidity, and 5-year survival rates.
Main Results:
- Hospital mortality rates were 2.3%, 3.7%, and 4.7% for Groups I, II, and III, respectively, with no operative deaths in any group.
- Older patients (Group III) exhibited more coronary artery lesions but better preserved left ventricular ejection fraction compared to younger groups.
- Five-year survival rates were high across all groups (93.4% to 96.9%), with most late deaths occurring within the first year post-CABG.
Conclusions:
- Coronary artery bypass grafting (CABG) demonstrates low operative mortality and satisfactory late survival in patients over 65, supporting its use in this demographic.
- Delayed postoperative functional recovery in the liver and kidneys, along with postoperative psychosis, were noted in aged patients.
- Preventing postoperative complications is vital for reducing hospital mortality in elderly patients undergoing CABG.
Abstract:
This study was undertaken in order to clarify the clinical characteristic features and surgical results of coronary artery bypass grafting (CABG) in patients over 65 years of age (group III, n = 43). These patients were compared with 2 other groups of patients, one aged between 50 and 59 years (group I, n = 88) and another aged between 60 and 64 years (group II, n = 54), with respect to mortality, morbidity and late survival. CABG was performed with the saphenous vein under cold K-Mg-cardioplegia with systemic hypothermia. The hospital mortality was 2.3, 3.7, and 4.7 per cent in groups I, II and III, respectively, although no operative mortality was noted in any group. The number of coronary artery lesions increased with age, however, the left ventricular ejection fraction was relatively better preserved in the aged patients than in the younger ones. The 5-year survival rates were 93.4, 95.1 and 96.9 per cent in groups I, II and III, respectively, with most of the late deaths occurring within a year after CABG in each group. In the aged patients, postoperative functional recovery was delayed in the liver and kidney, and postoperative psychosis was not infrequent. The results of this study, indicating a low operative mortality and satisfactory late survival rate, thus strongly support CABG for the aged. Nevertheless, the prevention of postoperative complications is also extremely important for reducing hospital mortality.