Coronary artery bypass grafting in elderly patients
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T Isomura1, K Hisatomi, A Hirano
1Second Department of Surgery, Kurume University Hospital, Fukuoka, Japan.
Insights
Coronary artery bypass grafting (CABG) in patients over 70 shows benefits, despite challenges like poorer vein graft quality and more aortic sclerosis. Long-term outcomes remain favorable for elderly individuals undergoing this procedure.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Vascular Grafting
Background:
- Elderly patients undergoing coronary artery bypass grafting (CABG) present unique challenges due to comorbidities and potential graft quality issues.
- Sclerotic changes in the ascending aorta and reduced saphenous vein quality are more prevalent in older populations.
Purpose of the Study:
- To evaluate the benefits and outcomes of CABG in patients aged 70 and above.
- To compare the results of CABG in elderly patients with those in younger patient cohorts.
Main Methods:
- Retrospective analysis of 37 patients over 70 undergoing CABG, compared with 177 younger patients.
- Assessment of lesion severity (three-vessel, left main), surgical urgency, graft types (saphenous vein graft vs. arterial graft), and aortic condition.
Main Results:
- Elderly patients had higher rates of three-vessel and left main lesions, and emergency surgery.
- Saphenous vein graft quality was often poor in the elderly, and ascending aorta showed more sclerosis.
- Postoperative ventilation time was longer in the elderly, but long-term functional outcomes (NYHA class I/II) were good, with low rates of angina.
Conclusions:
- CABG is beneficial for elderly patients, offering good long-term functional status despite increased surgical complexities.
- Careful consideration of aortic and graft quality is crucial for successful CABG in geriatric populations.
Abstract:
To determine the benefits of coronary artery bypass grafting (CABG) in elderly patients, we evaluated 37 patients more than 70 years old who underwent this surgical procedure and compared the results with those in 177 younger patients. Three-vessel lesions and left main lesion were seen in 78.4% and 48.6% of the elderly patients, respectively. Emergency or urgent surgery was performed on 19 patients and the number of distal anastomoses was 3.0 +/- 0.8 per patient. Left main lesion and emergency surgery were more common in elderly patients than in younger patients. Twelve patients received CABG with only a saphenous vein graft (SVG), while the remaining 25 patients had at least one arterial graft. The quality of the saphenous vein was poor to moderate in 50% of the elderly patients, while none of the arterial grafts showed significant sclerotic change. In 17 elderly patients, the ascending aorta showed sclerotic lesions and care was taken when completing proximal anastomoses of SVG to the aortic wall. After surgery, mechanical ventilation was required for an average of 29 h, which was longer than that in the younger patients. Postoperative low cardiac output, hypertension, and arrhythmia occurred in 6, 6 and 15 elderly patients, respectively. There were no early deaths, although there was one hospital death due to posttransfusion hepatitis. Thirty four elderly patients were classified as New York Heart Association functional class I or II during late follow-up maximum of 5 years) and only one had postoperative angina. The ascending aorta showed more sclerotic lesions, and the quality of the saphenous vein was worse, in the elderly patients.(ABSTRACT TRUNCATED AT 250 WORDS)