Aortocoronary bypass surgery in septuagenarians and octogenarians

Six hundred and twenty-nine consecutive patients between ages 70 and 79 and 64 patients over age 80 underwent isolated aortocoronary bypass operation with cardiopulmonary bypass. Four hundred and sixty-eight men and 161 women were between ages 70 and 79 (mean 73), and 41 men and 23 women were over age 80 (mean 82). Most patients were in NYHA Functional Class III (septuagenarian 25%, octogenarian 23%) and in Class IV (septuagenarian 59%, octagenarian 72%) preoperatively. Early death was reported in 41 (6.5%) septuagenarians and in 2 (3.1%) octogenarians. Cardiac-related late mortalities were 6.4% and 6.3%, respectively. Five hundred and eighty-eight septuagenarians and 62 octogenarians were over 30-day survivors; 17.5% (sept) and 35.9% (oct) developed major postoperative complications, including bleeding, pericardial tamponade, sternal dehiscence, myocardial infarction, arrhythmia and pump failure. Mean hospital stays were 14.8 and 19 days, respectively. At follow-up (mean 38.2 months) patients had significant functional improvement by one or more classes in 80% and 60%. Mortality was adversely influenced by (1) NYHA Class IV, (2) use of intra-aortic balloon pumping, (3) postoperative hemorrhage, and (4) prolonged ischemic cross-clamp time. This experience indicates that if adequate trial of medical treatment of angina fails in the elderly patient, aortocoronary bypass surgery becomes a successful alternative.