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[Aortocoronary bypass operation in the elderly patient: favorable long-term course]
Insights
Elderly patients over 64 undergoing coronary artery bypass grafting (CABG) experienced higher perioperative complications but showed comparable long-term survival and symptom relief to younger patients. This suggests CABG is a viable option for older individuals with coronary heart disease.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Outcomes Research
Context:
- Age is a significant risk factor in coronary artery bypass grafting (CABG).
- Evaluating outcomes in elderly populations undergoing major cardiac procedures is crucial for clinical decision-making.
- This study compares perioperative and long-term results of CABG in patients over 64 versus a younger matched cohort.
Purpose:
- To assess the perioperative risks and long-term prognosis of coronary artery bypass grafting in elderly patients (over 64 years).
- To compare outcomes between elderly patients and a younger, matched group (50-60 years) undergoing CABG.
- To determine the safety and efficacy of CABG in an aging population with coronary heart disease.
Summary:
- Elderly patients (over 64) undergoing CABG had higher rates of perioperative complications, including mortality, myocardial infarction, and cerebrovascular events, compared to younger patients (50-60).
- Despite increased perioperative risks, long-term survival rates at 1 and 5 years were similar between the elderly and younger groups.
- Both groups reported comparable improvements in symptom relief (thoracic pain) and overall condition post-CABG, with a trend favoring the elderly group in symptom-free status.
Impact:
- Coronary artery bypass grafting is a feasible and beneficial treatment option for carefully selected elderly patients with coronary heart disease.
- The findings support the consideration of CABG in older adults, balancing perioperative risks against significant long-term benefits in survival and quality of life.
- This research provides evidence for geriatric cardiology and cardiovascular surgery, informing risk stratification and patient management strategies for advanced age.
Abstract:
Age has been identified as an independent risk factor for coronary artery bypass grafting (CABG). We evaluated, therefore, the perioperative phase and long-term prognosis of all patients over the age of 64 (n = 80), who had been operated on for coronary heart disease at the University Hospital of Basel/Switzerland between 1979 and 1983. These elderly subjects were compared to 80 patients, 50 to 60 years old at the time of CABG, who were matched for degree of angina pectoris, coronary artery disease, left ventricular ejection fraction, sex and year of operation (matched-pairs analysis). Evaluation of long-term prognosis was based on regular clinical controls and on a questionnaire, sent to the patients in June 1984. During the perioperative phase 3 patients over 64 died versus 0 in the group of patients 50-60 years old. There were more complications in the older group (perioperative myocardial infarction 10 vs. 4, pulmonary embolism 2 vs. 0, cerebro-vascular insult 4 vs. 0). Three vs. one permanent pacemaker had to be implanted for irreversible AV-block. The difference in hospital stay, 21 vs. 19 days, was not significant. The cumulative survival rate was in both groups 95% after one year and 86 vs. 92% 5 years after CABG (difference not significant), despite the fact that significantly more elderly patients have had myocardial infarction prior to CABG. After an average follow-up of 28 months, 72% vs. 60% were without thoracic pain; 63 vs. 49% considered themselves in a good overall condition.(ABSTRACT TRUNCATED AT 250 WORDS)