[A personalized approach to determining the indications and strategy for coronary artery bypass grafting in elderly...

To analyze the fundamental factors determining the indications for myocardial revascularization in elderly and senile patients; to substantiate the main tactical decisions regarding the choice of conduit and method of CABG in patients with coronary artery disease.

The study included 633 patients who underwent CABG in 2018-2020. According to study objective, two groups of patients were formed: patients < 70 years constituted group A (n=486) and those over this age constituted group B (n=147). Mean age was 63.2±6.6 and 73.7±6.6 years, respectively. The authors analyzed some intraoperative parameters, possible impact of patient characteristics on intraoperative and postoperative period. Safety of surgeries in each group was assessed considering immediate postoperative period, including the incidence of perioperative complications and in-hospital mortality. Survival and quality of life for 5 years after surgery were determined by freedom from adverse cardiac events (MI, stroke, recurrent angina, and recurrent cerebrovascular accident). This part of the study included 41.9% of patients in group A and 42.1% in group B.

We found no significant between-group differences in intraoperative and postoperative parameters, with the exception of duration of mechanical ventilation (MV) after surgery. Ventilation was significantly longer in elderly patients. The incidence of perioperative complications was minor. An exception was atrial fibrillation in 18.3% of elderly patients (more than twice the incidence in younger patients). In-hospital mortality was minimal (one patient in each group). Five-year postoperative survival rate exceeded 95%. CABG provided high quality of life in both groups. Five years after surgery, 82.9% and 75.9% of patients in groups A and B had no clinical manifestations of coronary insufficiency, respectively.

This study demonstrates the importance of a personalized approach to surgical treatment of elderly and senile patients with coronary artery disease. Considering current clinical guidelines for the treatment and choice of myocardial revascularization, it is crucial to consider individual characteristics of elderly patients, including their physical and mental health status, comorbidities and their severity. Appropirate indications for surgery, selection of optimal tactics, and safe method for myocardial revascularization enable effective and long-lasting postoperative results in elderly and senile patients with coronary artery disease.