Coronary artery bypass in patients over 65 years of age

At the Vancouver General Hospital 235 consecutive patients (172 men, 63 women) aged 65 years or older underwent aortocoronary bypass grafting between January 1974 and December 1979; 168 were 65 to 69 years of age and 67 were 70 years or older. Concomitant cardiac procedures were carried out in 65 (valve surgery in 53, resection of ventricular aneurysm in 10, repair of ventricular septal defect in 1, excision of left atrial tumour in 1). A mean of 2.6 vessels per patient were grafted. Early mortality was 7.7%. For patients who underwent bypass grafting alone, the mortality for those 65 to 69 years was 5.1% and for those 70 years or older it was 5.9%. For patients who underwent bypass grafting and a concomitant procedure, the mortality for those 65 to 69 years of age was 3.1% and for those 70 years or older 24.2%. At follow-up (mean 30 months) there were 23 late deaths. The 5-year survival (life-table method) for the whole group was 77% including early deaths and 83% excluding early deaths. Late survival in those aged 70 years or older was similar to that in patients aged 65 to 69 years. Improvement in function was good; 92% of patients were in New York Heart Association functional class I or II at follow-up, where 94% had been in class III or IV before operation. Acceptable operative mortality with good long-term survival and lessening of symptoms support the use of aortocoronary bypass grafting in patients over 65 years of age. Complex procedures in those 70 years of age or older carry a high risk.