Related Experiment Videos
Determinants of operative mortality in octogenarians undergoing coronary bypass
D B Williams1, R G Carrillo, E A Traad
1Department of Thoracic and Cardiovascular Surgery, Mount Sinai Medical Center of Greater Miami, Miami Beach, Florida.
Insights
Coronary artery bypass grafting in patients over 80 years old shows a hospital mortality of 11%. Risk factors for mortality include renal dysfunction and pulmonary insufficiency, but outcomes can be favorable for those with severe angina.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Cardiac Surgery Outcomes
Background:
- Increasing elderly population necessitates consideration for advanced cardiac procedures.
- Surgeons face growing requests to evaluate octogenarians for coronary artery bypass grafting (CABG).
Purpose of the Study:
- Identify risk factors impacting mortality in octogenarians undergoing CABG.
- Analyze functional outcomes and survival rates in this patient group.
Main Methods:
- Study included 300 consecutive patients aged 80 and older undergoing CABG (July 1989-Feb 1994).
- Preoperative data included disabling angina (91.3%), left main coronary stenosis >50% (25.3%), and NYHA class III/IV (98.3%).
Main Results:
- Overall hospital mortality was 11.0% (33/300), with variations based on urgency.
- Predictors of operative mortality included preoperative/postoperative renal dysfunction, pulmonary insufficiency, intraaortic balloon pumping, and sternal wound infection.
- Actuarial survival at 54 months for discharged patients was 74.6% +/- 5.6%.
Conclusions:
- Coronary artery bypass grafting can yield favorable outcomes in octogenarians presenting with severe angina.
- Careful patient selection and management of risk factors are crucial for successful CABG in the elderly.
Background:
The elderly segment of the population is increasing rapidly, and surgeons are being asked to consider patients more than 80 years old as candidates for coronary bypass. The objective of this study was to identify risk factors that may adversely affect mortality as well as analyze functional outcomes and survival in octogenarians undergoing coronary bypass.
Methods:
From July 1989 through February 1994, 300 consecutive patients 80 years of age and older underwent coronary artery bypass grafting. There were 176 men (58.7%) and 124 women (41.3%) with a mean age of 80.9 years (range, 80 to 99 years). Preoperatively, 274 patients (91.3%) had disabling angina, 76 (25.3%) had left main coronary stenosis greater than 50%, and 293 patients (98.3%) were in New York Heart Association class III or IV.
Results:
The overall hospital mortality was 11.0% (33/300) with an elective mortality of 9.6% (23/240), urgent mortality of 11% (5/45), and emergent mortality of 33.3% (5/15). Significant independent predictors of operative mortality were preoperative renal dysfunction, postoperative pulmonary insufficiency, postoperative renal dysfunction, use of intraaortic balloon pumping, and sternal wound infection. The actuarial survival for patients discharged from the hospital was 74.6% +/- 5.6% (standard error of the mean) at 54 months.
Conclusions:
A favorable outcome may be expected when coronary artery bypass grafting is performed in patients 80 years of age or older with severe angina.