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[Surgery of the coronary vessels in the elderly]
Insights
Coronary artery bypass surgery in elderly patients improves survival and quality of life. Internal mammary artery grafts show superior long-term outcomes compared to other methods in this age group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Vascular Surgery
Context:
- Increasing prevalence of occlusive coronary artery disease in elderly populations.
- Need for effective surgical interventions in patients aged 65 and older.
- Aorto-coronary bypass as a potential treatment option for this demographic.
Purpose:
- To reevaluate the benefits and risks of aorto-coronary bypass in elderly patients.
- To assess the long-term outcomes and survival rates following coronary artery bypass surgery in older individuals.
- To compare the efficacy of different graft types, including internal mammary artery and saphenous vein grafts.
Summary:
- A study of 293 elderly patients (≥65 years) undergoing aorto-coronary bypass revealed an operative mortality of 4.8%.
- Long-term follow-up (mean 4.9 years) showed a late mortality of 4.6%/patient-year, with lower rates for internal mammary artery grafts (2.6%/patient-year) compared to saphenous vein grafts (p<0.05).
- Actuarial survival was 80% at six years, with 95% free from myocardial infarction, suggesting improved quality of life and survival.
Impact:
- Coronary surgery in the elderly leads to improved survival and quality of life.
- Internal mammary artery grafts demonstrate superiority in long-term outcomes for elderly patients.
- Provides evidence supporting the use of coronary artery bypass grafting in older adults with coronary artery disease.
Study Objective:
The rising numbers of elderly patients with occlusive coronary artery disease amenable to surgical correction prompted us to reevaluate the benefits and risks of aorto-coronary bypass in these patients.
Patients:
In the five-year period, from June 1980 through May 1985, 293 patients 65 years old and older (mean 69.1 years) and with a male: female ratio of 4:1, were subjected to aorto-coronary bypass.
Results:
Operative mortality was 4.8%, higher amongst 71 patients who had endarterectomy (8.5%) and those who had concomitant valve replacement (7.7%), but lower (2.5%) in the 99 patients who had only saphenous vein grafts (p less than 0.05). The survivors were followed for three to eight years (mean 4.9 years), with a cumulative follow-up of 1.005 patient-years. Late mortality was 4.6%/patient-year (46 patients), higher in patients with valve replacement (6.0%/patients-year; p less than 0.05), but lower in patients with internal mammary artery grafts (2.6%/patient-year). Late mortality was cardiac-related in 45.6% of the cases (21/46). Two patients were reoperated upon (0.2%/patient-year) and other two had percutaneous balloon angioplasty. Thirty six patients (12.9%) had recurrent angina during the period of follow-up, but the incidence was 20% in those who had only vein grafts (p = NS). Nine patients had myocardial infarction (0.9%/patient-year) of which six (67%) were fatal. In actuarial terms, 80% of the patients survived and 95% were free from myocardial infarction after six years.
Conclusions:
As in younger patients, coronary surgery in the elderly patient leads to improved life quality and survival. This study appears to confirm the superiority of internal mammary artery grafts also in the old patient.