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Coronary artery bypass surgery in patients aged 80 years or older
Insights
Coronary artery bypass grafting (CABG) is feasible in octogenarians, offering excellent functional improvement and long-term survival despite increased risks. This study shows acceptable outcomes for elderly patients undergoing this cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Octogenarian patients present unique challenges for cardiac surgery.
- Elderly individuals often have more severe coronary artery disease and left ventricular dysfunction.
- Limited data exists on the outcomes of coronary artery bypass grafting (CABG) in patients aged 80 and older.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass grafting (CABG) in octogenarian patients.
- To assess the mortality, morbidity, functional outcomes, and long-term survival in this specific patient cohort.
Main Methods:
- Retrospective analysis of 23 patients aged 80 years or older who underwent CABG between August 1980 and January 1986.
- Comparison of patient characteristics with the Coronary Artery Surgery Study (CASS) registry.
- Analysis of operative outcomes, complications, functional status (New York Heart Association class), and long-term survival.
Main Results:
- Octogenarian patients had a higher incidence of severe left main coronary artery narrowing, 3-vessel disease, and left ventricular dysfunction compared to younger patients.
- Elective CABG had a mortality rate of 11% (2/19), while emergency procedures had a 75% mortality rate (3/4).
- Intraaortic balloon counterpulsation was associated with a 67% mortality rate (4/6). Significant complications occurred in 50% of survivors.
- Operative survivors showed significant functional improvement (mean NYHA class improved from 3.7 to 1.6), with 13 of 16 long-term survivors in NYHA class I or II.
- Actuarial survival at 1 and 2 years was 94% and 82%, respectively.
Conclusions:
- Coronary artery bypass grafting (CABG) can be performed in octogenarian patients with increased, yet acceptable, mortality and morbidity risks.
- Elective CABG offers excellent functional improvement and long-term survival for elderly patients.
- Careful patient selection and surgical planning are crucial for successful outcomes in this high-risk group.
Abstract:
Between August 1980 and January 1986, 23 patients aged 80 years or older underwent coronary artery bypass grafting (CABG) operations. These patients had a higher incidence of severe left main coronary artery narrowing (p less than 0.0001), 3-vessel coronary artery disease (p less than 0.05) and moderate to severe left ventricular dysfunction (p less than 0.05) than patients in the Coronary Artery Surgery Study registry older than 65 years. Of 14 patients undergoing elective simple CABG procedures, none died; of 19 elective cases overall, 2 patients died (11%). Three of 4 patients undergoing emergency procedures (75%) and 4 of 6 patients (67%) requiring intraaortic balloon counterpulsation died. Significant complications occurred in 9 of 18 survivors (50%). All operative survivors improved at least 1 New York Heart Association class, with a mean classification improvement of 3.7 to 1.6 (p less than 0.0001); 13 of 16 long-term survivors were in class I or II. Actuarial survival at 1 and 2 years is 94% and 82%, respectively. CABG can be performed electively in octogenarian patients with increased but acceptable mortality and morbidity risks. Functional improvement and long-term survival are excellent.