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Surgical Outcomes in Octogenarians with Heart Failure and Reduced Ejection Fraction following Isolated Coronary
Christian Jörg Rustenbach1, Rodrigo Sandoval Boburg1, Medhat Radwan1
1Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72074 Tübingen, Germany.
Insights
Coronary artery bypass grafting (CABG) is safe for octogenarians with heart failure and reduced ejection fraction (HFrEF). This study found no significant differences in major adverse cardiac and cerebrovascular events (MACCEs) or mortality between older and younger patients undergoing CABG.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Cardiac Anesthesia
Background:
- Aging global population necessitates reevaluating surgical interventions for elderly patients.
- Octogenarians with heart failure and reduced ejection fraction (HFrEF) are often considered high-risk for coronary artery bypass grafting (CABG).
Purpose of the Study:
- To evaluate the outcomes of isolated CABG in octogenarians (≥80 years) with HFrEF.
- To compare the incidence of major adverse cardiac and cerebrovascular events (MACCEs) and other clinical endpoints between octogenarians and younger patients with HFrEF undergoing CABG.
Main Methods:
- Retrospective, multicenter study conducted in Germany (2017-2023).
- 100 patients with HFrEF undergoing isolated CABG, propensity score matched into two groups: 50 octogenarians (≥80 years) and 50 non-octogenarians (<80 years).
- Statistical analysis included chi-square, ANOVA, Mann-Whitney U test, Cox regression, and logistic regression.
Main Results:
- No significant difference in MACCEs incidence between octogenarians and non-octogenarians (OR: 0.790, p=0.759).
- Similar mortality rates (7% each), postoperative myocardial infarction (2% each), and stroke rates (3% total) between groups.
- No significant age-related differences observed in delirium, acute kidney injury, or need for dialysis; non-octogenarians required more blood transfusions.
Conclusions:
- CABG is a viable and safe surgical option for octogenarians with HFrEF.
- Age alone should not preclude octogenarians with HFrEF from CABG; careful patient selection and perioperative management are key.
- Findings support a more inclusive approach to surgical treatment for this high-risk demographic, potentially requiring tailored guidelines.
Abstract:
Background/Objectives: The demographic shift towards an aging population necessitates a reevaluation of surgical interventions like coronary artery bypass grafting (CABG) in octogenarians. This study aims to elucidate the outcomes of CABG in octogenarians with heart failure and reduced ejection fraction (HFrEF), a group traditionally considered at high risk for such procedures. Methods: Conducted across four academic hospitals in Germany from 2017 to 2023, this retrospective multicenter study assessed 100 patients (50 octogenarians ≥80 years and 50 non-octogenarians <80 years) with HFrEF undergoing isolated CABG. Through propensity score matching, the study aimed to compare the incidence of major adverse cardiac and cerebrovascular events (MACCEs), as well as other clinical endpoints, between the two groups. Statistical analyses included chi-square, ANOVA, Mann-Whitney U test, Cox regression, and logistic regression, aiming to identify significant differences in outcomes. Results: The study revealed no significant difference in the combined incidence of MACCEs between octogenarians and non-octogenarians (OR: 0.790, 95% CI: 0.174-3.576, p = 0.759). Mortality rates were similar across groups (7% each, p = 1.000), as were occurrences of postoperative myocardial infarction (2% each, p = 1.000) and stroke (3% total). Secondary outcomes like delirium (17% total, no significant age group difference, p = 0.755), acute kidney injury (18% total, p = 0.664), and the need for dialysis (14% total, p = 1.000) also showed no differences between age groups. Interestingly, non-octogenarians required more packed red blood cells during their stay (p = 0.008), while other postoperative care metrics, such as hospital and ICU length of stay and ventilation hours, were comparable across groups. Conclusion: This multicenter study highlights that CABG is a viable and safe surgical option for octogenarians with HFrEF, challenging prior assumptions about the elevated risks associated with performing this procedure in older patients. The absence of significant differences in the incidence of MACCEs and other postoperative complications across age groups emphasizes the importance of careful patient selection and perioperative management. These findings advocate for a more inclusive approach to surgical treatment for octogenarians with HFrEF, suggesting that age alone should not be a determinant for CABG eligibility. This study contributes critical insights into optimizing care for a high-risk demographic, indicating a need for tailored guidelines that accommodate the aging population with complex cardiac conditions.
