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Coronary artery surgery in the elderly: long-term follow-up
P N Ruygrok1, T M Agnew, H A Coverdale
1Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
Insights
Coronary artery bypass grafting (CABG) in elderly patients shows a 96% hospital survival and 77% five-year survival. Long-term outcomes include significant angina relief and manageable heart failure symptoms.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Outcomes Research
Background:
- Controversy exists regarding the indications for coronary artery surgery in elderly populations, especially in resource-limited settings.
- Assessing the risks and long-term benefits of coronary artery bypass grafting (CABG) in older adults is crucial.
Purpose of the Study:
- To evaluate the outcomes of isolated coronary artery bypass grafting (CABG) in patients aged 70 years and older.
- To analyze both the immediate surgical risks and the long-term follow-up results in this elderly cohort.
Main Methods:
- A consecutive series of 96 elderly patients (≥70 years) underwent isolated CABG between 1981 and 1985.
- Long-term follow-up was achieved in 98% of patients, with a mean follow-up of 73 months.
Main Results:
- Hospital survival was 96%, with a 5-year survival rate of 77%.
- Long-term survival was not significantly affected by factors like gender, myocardial score, ejection fraction, or age.
- Among survivors, 64% were angina-free, while 31% experienced heart failure symptoms.
Conclusions:
- Coronary artery bypass grafting (CABG) is a viable option for selected elderly patients, offering substantial long-term survival and symptom relief.
- Careful patient selection and risk assessment are essential for optimizing outcomes in geriatric cardiac surgery.
Background:
There has been controversy concerning the indications for coronary artery surgery in the elderly, particularly in countries where health resources are restricted.
Aims:
To assess the results of coronary artery bypass grafting (CABG) in a large group of elderly subjects with regard to initial risks and long term follow-up.
Methods:
Ninety-six consecutive patients aged 70 years or older underwent isolated CABG between January 1981 and December 1985. Long term follow-up was obtained in 94 (98%).
Results:
The mean age was 71.6 years (70-78) and mean duration of follow-up 73 months. Seventy (73%) were male. In 80 cases the myocardial score was > 10. In 22 of 90 who had left ventricular angiography the ejection fraction was < 50%. Hospital survival was 96% and the five year survival 77%. It was not influenced by gender, myocardial score, ejection fraction or age at the time of operation. The status of survivors was reviewed in 1991. Of the 55 long term survivors 35 (64%) were free of angina. Eight (15%) and ten (18%) were in the Canadian Cardiovascular Society Angina classes 1 and 2 respectively. Seventeen patients (31%) had symptoms of heart failure with 14 (25%) in NYHA class 2 and 3 (5%) in class 3. Eight patients (15%) had survived a cerebrovascular event during follow-up. There were 35 late deaths (37%). Sixteen of these were cardiac, 18 due to other causes and one unknown.