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[Indications and results of coronary surgery in patients aged 70 or more]
Insights
Coronary bypass surgery is safe and effective for patients over 70. Elderly patients with severe coronary artery disease experienced excellent outcomes, with no deaths or heart attacks post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Coronary artery disease affects a significant elderly population.
- Surgical intervention in patients over 70 requires careful consideration due to potential risks.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass grafting (CABG) in patients aged 70 and above.
- To assess the outcomes of CABG in elderly patients with severe coronary artery disease.
Main Methods:
- Retrospective analysis of 400 consecutive CABG patients.
- Detailed review of 20 patients aged 70 or more undergoing CABG.
- Assessment of coronary arteriography, ventricular function, and clinical outcomes.
Main Results:
- No deaths or postoperative myocardial infarctions occurred in the elderly group.
- Only 2 patients experienced residual angina during a 2.5-year follow-up.
- Elderly patients had more severe coronary lesions but generally normal ventricular function.
Conclusions:
- Coronary bypass surgery yields excellent results in carefully selected elderly patients.
- Age should not be a barrier to pre-surgical arteriography and potential CABG in invalidated elderly patients.
- Stricter patient selection contributes to favorable outcomes in this age group.
Abstract:
Among 400 consecutive patients who underwent coronary bypass performed by the same surgical team, 20 (5%) were aged 70 or more (mean: 71.52 years). This group represented one-third of coronary arteriographies carried out at that age. Most patients had stage III or IV coronary disease. All were seriously invalidated but in good general condition without systemic disease or dangerous arterial lesions. Coronary arteriography showed highly surgical lesions in all 20 cases, with 3-vessel lesions in 45% and tight stenosis of the main vessel in 25%. Ventricular function was generally normal. The average number of bypasses per patient (1.65) was distinctly lower than in younger subjects. The results obtained were most encouraging, with no death and no myocardial infarction either postoperatively or during a mean follow-up period of 2.5 years. Only 2 patients had residual angina. Compared with operated patients under 70, this group was characterized by a longer duration of the disease prior to surgery and by a higher percentage of severe clinical stages and life-threatening and highly surgical lesions. Post-operative and medium-term results were also distinctly better, probably because of stricter selection for surgery. All this has been confirmed in several North American publications which also report excellent results in patients over 70 years of age. To conclude, there are excellent reasons for performing coronary bypass in these elderly patients and age should not preclude pre-surgical arteriography, especially when the patient is seriously invalidated and when his general condition is sufficiently good to tolerate cardiopulmonary bypass.