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CABG in octogenarians: early and late events and actuarial survival in comparison with a matched population
1Department of Thoracic and Cardiovascular Surgery, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015, USA.
Insights
Coronary artery bypass grafting in octogenarians carries increased risk but offers acceptable outcomes. Survivors achieve good functional status, though long-term survival is impacted by pulmonary and atherosclerosis-related conditions.
Area of Science:
- Cardiology
- Geriatric Surgery
- Thoracic Surgery
Background:
- Increasing numbers of elderly patients are undergoing complex cardiac surgeries.
- There is ongoing debate regarding the efficacy of healthcare resource allocation for older populations in maintaining quality of life.
Purpose of the Study:
- To evaluate the outcomes of coronary artery bypass grafting (CABG) in octogenarians.
- To identify risk factors associated with mortality in this patient group.
Main Methods:
- Retrospective review of medical records for 121 octogenarians who underwent CABG between 1982 and 1991.
- Follow-up data obtained via telephone contact with patients, families, or physicians.
Main Results:
- The study included 121 patients (mean age 82.1 years), with 69% presenting with New York Heart Association class III or IV symptoms.
- Hospital mortality was 9.1%, with risk factors including longer cardiopulmonary bypass time, higher left ventricular end-diastolic pressure, advanced age, renal disease, and myocardial infarction.
- Late mortality occurred in 30.9% of patients; risk factors included COPD, elevated left ventricular end-diastolic pressure, and recent myocardial infarction. Actuarial survival at 80 months was 32.8%, comparable to a matched population. 84% of late survivors had good functional status (NYHA class I or II).
Conclusions:
- Coronary artery bypass grafting can be performed in octogenarians with acceptable, albeit increased, risk.
- Hospital survivors generally experience good long-term functional status.
- Pulmonary and atherosclerosis-related complications pose risks to overall survival in this population.
Background:
With important demographic changes in cardiac surgical practice, more older patients are undergoing complex cardiac operations. Controversy exists as to whether the expenditure of healthcare resources on the growing elderly populations represents an effective approach in maintaining a meaningful quality of life.
Methods:
From January 1982 through April 1991, 121 consecutive octogenarians underwent a surgical procedure that included coronary artery bypass grafting. Retrospective review of patient medical records was performed; follow-up information was obtained via telephone contact with the patient, the patient's family, or the patient's physician.
Results:
There were 67 men (55%) and 54 women (45%). Mean age was 82.1 years (range, 80 to 89 years). Sixty-nine percent of the patients were having class III or IV symptoms. There were 11 hospital deaths (9.1%); risk factors included longer cardiopulmonary bypass time (p = 0.01), higher preoperative left ventricular end-diastolic pressure (p = 0.02), advanced age (p = 0.05), history of renal disease (p = 0.02), and myocardial infarction (p = 0.04). Late death occurred in 34 patients (30.9%) at a mean of 27 months postoperatively; univariate risk factors included chronic obstructive pulmonary disease (p = 0.009), higher left-ventricular end-diastolic pressure (p = 0.03), and recent myocardial infarction (p = 0.03). Actuarial survival, including hospital death, was 32.8% at 80 months, compared with 37.6% for an age; sex; and race-matched population (p > 0.3). Most late survivors (84%) were in New York Heart Association class I or II.
Conclusions:
We conclude that coronary artery bypass grafting can be performed in octogenarians with an acceptable, although increased risk. Hospital survivors have a good late functional status but are at risk for pulmonary and other atherosclerosis-related events, which impair overall survival.