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[Coronary artery bypass surgery in patients aged 75 years or older]
Y Nakai1, M Bando, T Nishimura
1Department of Cardiology, Komatsushima Red Cross Hospital, Tokushima, Japan.
Insights
Coronary artery bypass grafting (CABG) is safe for patients 75+ if stable preoperatively. Emergency CABG showed higher mortality (33.3%) and complications like low cardiac output syndrome.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
Context:
- Elderly patients (≥75 years) present unique challenges for cardiac surgery.
- Coronary artery bypass grafting (CABG) outcomes in this demographic require careful evaluation.
Purpose:
- To assess the safety and outcomes of CABG in patients aged 75 years and older.
- To identify risk factors and major complications associated with CABG in this population.
Summary:
- Sixteen patients aged 75+ underwent CABG, with an overall mortality rate of 12.5%.
- Elective CABG had 0% mortality, while urgent/emergent cases had 33.3% mortality.
- Major complications included altered mental status, low cardiac output syndrome (LOS), pulmonary, and renal dysfunction. No correlation was found between preoperative CT findings and postoperative confusion.
Impact:
- CABG can be performed safely in elderly patients (≥75 years) when they are hemodynamically stable preoperatively.
- Highlights the increased risk associated with emergent CABG in older adults, particularly after failed percutaneous transluminal coronary angioplasty.
- Informs surgical decision-making and risk stratification for geriatric cardiac surgery patients.
Abstract:
16 patients 75 years of age or older underwent coronary artery bypass grafting. The overall hospital mortality rate was 12.5% (2/16), 0% for elective procedures, 33.3% for urgent and emergent cases. 4 of 6 patients underwent emergency CABG after failed percutaneous transluminal coronary angioplasty. Major complications were altered mental status, low cardiac output syndrome (LOS), pulmonary dysfunction and renal dysfunction. One patient who died had LOS. Another patient who died occurred multiple organ failure after pulmonary dysfunction from self-extubation. There was no correlation the incidence of postoperative confusion and preoperative cerebral CT findings. CABG can be performed safely in patients 75 years or older, if the preoperative conditions are stable.