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[Myocardial revascularization in aged patients: what is the surgical risk?]
G Pompilio1, C Antona, S Musumeci
1Cattedra di Cardiochirurgia, Università degli Studi, Centro Cardiologico Fondazione I Monzino, Milano.
Insights
Coronary artery bypass grafting (CABG) in patients over 75 shows similar cardiac outcomes but increased non-cardiac complications compared to younger patients. This highlights the need for careful risk assessment in elderly individuals undergoing CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Controversies exist regarding surgical outcomes of myocardial revascularization in the elderly.
- Assessing cardiac and non-cardiac morbidity and mortality is crucial for this population.
Purpose of the Study:
- To retrospectively evaluate the surgical results of coronary artery bypass grafting (CABG) in patients over 75 years old.
- To compare outcomes between elderly patients and a younger control group.
Main Methods:
- Retrospective analysis of 71 patients over 75 undergoing elective CABG (Group A) compared to a control group younger than 75 (Group B).
- Subgroup analysis based on coronary artery disease severity and echocardiographic ejection fraction.
- Comparison of operative mortality, cardiac morbidity (myocardial infarction, atrioventricular block), and non-cardiac complications (neurologic, renal, respiratory).
Main Results:
- Left internal thoracic artery utilization was significantly lower in Group A (57.7%) vs. Group B (97.1%).
- Operative mortality was 4.2% in Group A, with no deaths in Group B.
- Cardiac morbidity (myocardial infarction, atrioventricular block) showed no significant differences between groups.
- Non-cardiac complications were significantly higher in Group A: neurologic (11.2% vs. 1.4%), renal insufficiency (12.6% vs. 1.4%), and respiratory failure (9.8% vs. 1.4%).
Conclusions:
- While cardiac outcomes are comparable, elderly patients (>75) undergoing CABG experience a higher incidence of non-cardiac complications.
- Careful preoperative risk stratification and management are essential for optimizing CABG outcomes in the aged population.
Abstract:
There are still controversies about the surgical results of myocardial revascularization in aged population, in terms of cardiac and non-cardiac morbidity and mortality. This issue prompted us to study retrospectively 71 patients older than 75 years electively operated of coronary artery bypass grafting (CABG) from June 1990 to June 1993 (Group A). Elderly population was compared with a contemporaneous and concurrent control group of patients younger than 75 years (Group B). Patients > 75 years have been divided in successive subgroups according to the severity of coronary artery disease (3 vessel disease 67.7%, 2 vessel disease 26.7%, 1 vessel disease 5.6%), echocardiographic ejection fraction (EF > 50%: 40.8%; 50-30%: 42.2%; < 30%: 16.9%) and preoperative risk factors. Left internal thoracic artery (LITA) utilization rate was 97.1% in Group B and 57.7% in Group A (p < 0.001). Cardiopulmonary bypass circulation, aortic cross-clamping time and number of coronary anastomoses were similar in the 2 groups (2.87 +/- 0.9 versus 2.8 +/- 0.8, NS). Operative mortality rate of aged population was 4.2% while no patient of Group B died (NS). Concerning the cardiac morbidity, there were no significantly differences between the 2 groups: myocardial infarction occurred in 3 patients of Group B (4.2%) and in 5 patients of Group A (7%; NS). Atrioventricular block was also similar in the 2 groups. Non-cardiac complications occurred more frequently in the aged population group: neurologic complications in 11.2% versus 1.4% (p < 0.04), renal insufficiency in 12.6% versus 1.4% (p < 0.03) and respiratory failure in 9.8% versus 1.4% (p = 0.06). (ABSTRACT TRUNCATED AT 250 WORDS)