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Coronary artery bypass grafting in the octogenarian. Is complete revascularization always necessary?

Giovanni Concistrè, Angelo Maria Dell'Aquila, Alina Gallo

    Annali Italiani Di Chirurgia
    |March 31, 2015
    PubMed

    Insights

    In octogenarians undergoing coronary artery bypass grafting (CABG), incomplete revascularization (IRV) does not impact survival or major adverse cardiac and cerebrovascular events (MACCE). Preoperative patient condition is key for outcomes in this age group.

    Area of Science:

    • Cardiovascular Surgery
    • Geriatric Cardiology
    • Outcomes Research

    Background:

    • Completeness of revascularization is crucial for coronary artery bypass grafting (CABG) outcomes in younger patients.
    • The impact of revascularization completeness on outcomes in octogenarians (patients aged 80 and above) remains less defined.

    Purpose of the Study:

    • To investigate whether complete revascularization (CRV) influences outcomes in octogenarian patients undergoing isolated CABG.
    • To determine if incomplete revascularization (IRV) is a risk factor for mortality or adverse events in this elderly population.

    Main Methods:

    • Retrospective review of 130 octogenarians who underwent isolated CABG between 2003 and 2010.
    • Patients were categorized into Complete Revascularization (CRV) and Incomplete Revascularization (IRV) groups.
    • Follow-up was 98% complete, with a mean duration of 30 months.

    Main Results:

    • Overall in-hospital mortality was 13% and not significantly different between CRV and IRV groups.
    • Multivariate analysis identified low ejection fraction and high NYHA class as risk factors for in-hospital death.
    • Cox regression revealed no significant difference in early or late death, 5-year survival, or freedom from MACCE between CRV and IRV groups.

    Conclusions:

    • In octogenarians undergoing CABG, incomplete revascularization does not adversely affect survival or freedom from MACCE.
    • Preoperative patient factors, such as left ventricular ejection fraction and NYHA class, are more critical in determining outcomes.
    • The survival benefit of CRV may be less pronounced in octogenarians compared to younger patients due to shorter life expectancy.
    Abstract

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