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[Aortocoronary venous bypass operation in the elderly]
V K Kothe1, B Porstmann, R Aurisch
1Universitätsklinik für Innere Medizin, Bereiches Medizin (Charité) der Humboldt Universität zu Berlin.
Insights
Older patients undergoing aorto-coronary venous bypass (ACVB) surgery face higher risks of perioperative myocardial damage and low output syndrome. However, with intensive care, these risks are manageable, proving ACVB is beneficial for improving quality of life in this group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Clinical Risk Assessment
Context:
- Extended diagnosis for aorto-coronary venous bypass (ACVB) operations involves high-risk patients, including those with unstable angina pectoris (inApS), left main artery disease (LAD), and reduced ejection fraction.
- Preoperative risk stratification is crucial for identifying patients who may experience complications.
Purpose:
- To evaluate the perioperative risk and postoperative outcomes in patients aged over 60 undergoing extended ACVB operations.
- To compare complication rates and long-term quality of life between older and younger patient groups.
Summary:
- A study of 600 patients undergoing ACVB operations, with 150 high-risk patients monitored for complications, found that patients over 60 experienced increased rates of perioperative myocardial damage (PMD) and low output syndrome (LOS) (p < 0.001).
- Despite a higher incidence of PMD and LOS in older patients, hospital mortality was not significantly increased.
- Intensive therapeutic measures effectively managed these complications in the majority of older patients.
Impact:
- Urgent ACVB operations are strategically sound for improving quality of life and life expectancy in patients over 60, particularly those with inApS and LAD.
- Individualized intensive care can mitigate the increased perioperative risks associated with ACVB in elderly patients.
- The study highlights the importance of tailored management strategies for high-risk elderly patients undergoing complex cardiac surgery.
Abstract:
On the extended diagnosis for an aorto-coronary venous bypass operation, with a greater involvement of patients with instable angina pectoris symptomatik (inApS), left main artery disease (LAD), aneurysmal resection, and "bad" ventricle (ejection fraction global less than or equal to 30%), the preoperative risk was evaluated in n = 600 patients. In a total of n = 150 patients with preoperative high-risk constellation perioperative parameters were monitored to find complications (perioperative myocardial damage [PMD], cardiac low output syndrome [LOS]). Among them were n = 40 patients aged greater than 60 years (60-72), their average age being 62.9 years. In 30% of these older patients the preoperative high-risk constellation was confirmed: 15% PMD, 10% LOS, and 5% deceased. The further postoperative course (up to the 6th month) is objectified by the ejection fraction global (EFg) by multiple checks. As a whole, patients greater than 60 years with extended diagnosis for ACVB operation do not show any significant increase in hospital mortality, but an increase in PMD and LOS (p less than 0.001) compared to the age group less than 60 years. With corresponding individual intensive-therapeutic measures, however, both complications can be controlled in the majority of patients. Despite the demonstrated higher perioperative risk, the urgent ACVB operation proved to be strategically right (considering the results of EFg) for increasing the quality of life and improving the expectation of life also for patientes greater than 60 years, in particular with the operation indications of inApS and LAD.(ABSTRACT TRUNCATED AT 250 WORDS)