Myocardial revascularisation in patients over seventy five years
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R F Saldanha1, J Raman, D S Esmore
1Cardiothoracic Surgical Unit, St. Vincent's Hospital, Sydney, Australia.
Insights
Coronary artery bypass graft surgery in elderly patients (75+) shows encouraging results. Careful patient selection and monitoring led to low mortality and no peri-operative myocardial infarction, with most patients achieving good functional status.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Cardiac Surgery Outcomes
Background:
- Elderly patients (75+) present unique challenges for cardiac surgery.
- Unstable angina and congestive heart failure are common pre-operative conditions in this demographic.
- Significant coronary artery disease, including triple vessel disease and left main obstruction, is prevalent.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass graft (CABG) surgery in patients aged 75 years and above.
- To assess peri-operative outcomes, including mortality and complications.
- To determine long-term functional status following CABG in the elderly population.
Main Methods:
- A consecutive series of 73 patients aged 75+ underwent CABG over a 6-year period.
- Data collected included pre-operative conditions, surgical details (e.g., number of grafts, combined procedures), and post-operative outcomes.
- Follow-up data was obtained for 60 patients to assess long-term functional class.
Main Results:
- Hospital mortality was 2.7% with no peri-operative myocardial infarction.
- Common post-operative complications included atrial arrhythmias (43.8%) and pulmonary atelectasis (43.8%).
- Of 60 followed patients, 58 (96.7%) achieved NYHA Functional Class I at an average of 27.7 months.
Conclusions:
- Coronary artery bypass graft surgery can be performed with encouraging results in carefully selected elderly patients (75+).
- Meticulous patient selection and vigilant post-operative monitoring are crucial for successful outcomes.
- The procedure leads to significant improvement in long-term functional capacity for this age group.
Abstract:
A consecutive series of 73 patients aged 75 years and above underwent coronary artery bypass graft surgery during a 6 year period. Pre-operatively unstable angina (61.6%) and congestive heart failure (10.9%) were significant presenting features. Triple vessel disease accounted for 61.6% of cases while 26% had left main coronary obstruction. The mean number of grafts per patient was 3.2 +/- 0.9. Combined procedures such as valve replacement were done in 16.2% of patients. The hospital mortality rate was 2.7% and there was not a single recordable case of peri-operative myocardial infarction. Significant complications post-operatively were atrial arrhythmias (43.8%), segmental pulmonary atelectasis (43.8%) and renal problems (15%). Of the sixty patients followed up at an average of 27.7 months, 58 were in NYHA Functional Class I. Good patient selection and careful monitoring leads to encouraging results with coronary artery bypass grafting in the elderly.