[Indications for aortocoronary bypass operation in elderly patients: medical point of view]

Aorto-coronary (A-C) bypass operations were performed in 20 patients aged 68 to 78 years, and the indications for this operation were discussed retrospectively. The subjects consisted of 14 patients successfully operated and six patients unsuccessfully operated (death 3, graft occlusion 2, perioperative infarction 1). The results were as follows: Average age: There was no difference between the successful group (71.1 +/- 3.3 years; mean +/- SD) and the unsuccessful group (70.3 +/- 2.9 years). Coronary arteriographic findings: The average number of narrowed branches (greater than or equal to 75% stenosis) was 4.3 +/- 3.0 in the successful group (triple vessel disease in 12 cases and double vessel disease in four) and 2.7 +/- 0.5 in the unsuccessful group (triple vessel disease in four and double vessel disease in two), showing no significant difference between the two groups. Nine patients (64.3%) in the former group and one (16.7%) in the latter group had significant left main coronary artery disease (greater than or equal to 50% stenosis). Hemodynamic findings: Ejection fractions of less than 40% existed in three patients (50%) solely in the unsuccessful group; two of whom died. Left ventricular end-diastolic pressures of 30 mmHg or more existed in two cases (33.3%) only in the latter group. Other cardiac findings: Left ventricular end-diastolic dimension of 55 mm or more was found in one (7.1%) successful case and four (66.7%) unsuccessful cases. 201Tl-scintigrams showed a dilated left ventricular cavity in one case (7.1%) in the former group and two (33.3%) in the latter. Functions of other organs: Forced expiratory volume 1.0% or % vital capacity less than 70% was recognized in two cases (33.3%) only in the latter group. A level of serum creatinine more than 1.5 mg/dl was seen in only one case in the latter group. A case with advanced diabetes mellitus was present in the unsuccessful group, and this patient died of diabetic coma. A-C bypass operations are indicated for elderly patients when they have good cardiac function and have no complications of the kidneys, lungs and other organs. It is presumed that grafting the main coronary branches, thereby shortening the time of cardiopulmonary arrest prevents postoperative complications.