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Outcomes of isolated reoperative coronary artery bypass grafting in elderly patients

Mohammed Al-Jughiman1, Khaled Algarni, Terrence Yau

  • 1Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Prince Sultan Cardiac Center, Al-Ahsa, Saudi Arabia.

Journal of Cardiac Surgery
|November 4, 2014
PubMed

Insights

Reoperative coronary artery bypass grafting (CABG) in elderly patients (≥75 years) carries a threefold increased mortality risk compared to primary CABG, driven by myocardial infarction and low cardiac output syndrome.

Area of Science:

  • Cardiovascular Surgery
  • Geriatric Cardiology
  • Outcomes Research

Background:

  • Coronary artery bypass grafting (CABG) is a common procedure in elderly patients.
  • The risks and outcomes of reoperative CABG in this age group are not well-established.
  • Understanding these factors is crucial for optimizing patient care.

Purpose of the Study:

  • To compare the risk profile and hospital outcomes of isolated reoperative CABG versus isolated primary CABG in elderly patients (≥75 years).
  • To identify predictors of hospital mortality in elderly patients undergoing reoperative CABG.

Main Methods:

  • A retrospective analysis of 3483 elderly patients (≥75 years) who underwent isolated CABG between 1990 and 2010.
  • 129 patients (3.7%) underwent reoperative CABG.
  • Multivariable logistic regression was used to determine independent predictors of hospital mortality.

Main Results:

  • Hospital mortality was significantly higher in the reoperative group (8.5%) compared to the primary group (3.2%).
  • Perioperative myocardial infarction (MI) and low cardiac output syndrome (LCOS) were significantly more frequent in the reoperative group.
  • Combined antegrade and retrograde cardioplegia use was associated with lower MI and mortality in reoperative patients.

Conclusions:

  • Elderly patients undergoing reoperative CABG face a substantially higher mortality risk than those undergoing primary CABG.
  • Increased rates of perioperative MI and LCOS contribute to the higher mortality in reoperative cases.
  • The combined use of antegrade and retrograde cardioplegia appears to be a protective factor against mortality in elderly patients undergoing reoperative CABG.
Abstract

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