Coronary arteries bypass grafting surgery in elderly patients
Feridoun Sabzi1, Hashem Kazerani, Arash Jalali
1Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Insights
Coronary artery bypass grafting (CABG) in patients over 70 is associated with increased surgical risks and postoperative complications, including higher rates of death and pulmonary issues, compared to younger patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Increasing incidence of coronary artery bypass grafting (CABG) in elderly populations.
- Contradictory findings regarding early outcomes of CABG in elderly versus younger patients.
Purpose of the Study:
- To compare the early outcomes of on-pump CABG between elderly (≥70 years) and younger (<70 years) patients.
- To identify specific surgical risks and postoperative complications associated with CABG in the elderly.
Main Methods:
- Retrospective analysis of 1489 on-pump CABG cases.
- Comparison of perioperative variables between two age groups: ≤70 years (Group A) and >70 years (Group B).
- Statistical analysis using t-tests, X(2) tests, and multivariate logistic regression.
Main Results:
- Elderly patients (Group B) had higher rates of preoperative myocardial infarction, emergent surgery, chronic obstructive pulmonary disease, and preoperative creatinine >1.5 mg/dl.
- Group B also experienced more postoperative low cardiac output syndrome, inotropic drug use, intra-aortic balloon pump use, infection, pulmonary complications, renal complications, and death.
- Younger patients (Group A) had higher values for weight, preoperative PO2, ejection fraction >30%, body surface area, and hypercholesterolemia.
Conclusions:
- CABG in elderly patients carries significant surgical risks, including higher mortality and complication rates.
- Postoperative complications such as pulmonary issues, infections, and the need for intensive support (inotropic drugs, IABP) are more frequent in older individuals.
- The study highlights the increased vulnerability of elderly patients undergoing CABG surgery.
Background:
The incidence of coronary artery bypass grafting surgery (CABG) in elderly patients has been increasing. There are contradictory reports on the early outcome of elderly coronary artery patients as compared with their young counterparts. We designed this retrospective study to address this issue.
Methods:
We retrospectively analyzed the results of 1489 on-pump CABG cases performed at our hospital during a 4.5-year period. Perioperative data such as demographic, medical, clinical, operative, and postoperative variables were collected and compared between patients 70 years old or younger (Group A, n = 1164) and patients above 70 years of age (Group B, n = 325). Statistical analysis was performed using the t-test for the continuous and the X(2) tests for the categorical variables. Significant variables according to the univariate analysis (X(2) and t-test) were further analyzed using multivariate logistic regression analysis.
Results:
The variables of weight (P value < 0.001), preoperative PO2 (P value = 0.005), ejection fraction > 30% (P value = 0.001), body surface area (P value = 0.003), and hypercholesterolemia (P value = 0.007) were higher in Group A, whereas preoperative myocardial infarction (P value < 0.001), postoperative low cardiac output syndrome (P value = 0.019), emergent surgery (P value = 0.003), inotropic drug use (P value < 0.001), preoperative heparin use (P value < 0.001), re-exploration for bleeding (P value = 0.015), hospital stay (P value < 0.001), low ejection fraction (≤ 30%) (P value = 0.001), preoperative creatinine > 1.5 mg/dl (P value < 0.001), chronic obstructive pulmonary disease (P value < 0.001), intra-aortic balloon pump use (P value < 0.001), infection (P value < 0.001), pulmonary complications (P value < 0.001), atrial fibrillation (P value < 0.001), postoperative renal complications (P value < 0.001), and death (P value = 0.012) were more frequent in Group B.
Conclusion:
CABG in the elderly patients had certain surgical risks such as chronic obstructive pulmonary disease, preoperative myocardial infarction, emergent surgery, and death. Also, postoperative complications such as pulmonary complications, inotropic drug use, intra-aortic balloon pump use, and infection were more frequent in the elderly than in the younger patients.
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