[Myocardial revascularization in the patient over 70: our experience]

Since September 1985 to June 1994, 252 patients (70 years and older) underwent coronary artery bypass grafting isolated or combined with other surgical procedures. Mean age was 73 +/- 4.3 years (range: 70-84). Associated non-cardiac diseases were present in 131 patients (52%). Concomitant surgical procedures were performed in 34 patients (13.5%). Myocardial revascularization was accomplished under emergency conditions in 18.1% of patients. Overall operative mortality was 5.5% (n = 14). Isolated coronary artery bypass grafting operative mortality was 3.9% (n = 10). In-hospital death rate was higher (11.7%; n = 4) for coronary artery bypass grafting associated with other procedures. During the same period, the overall mortality rate for patients younger than 70 years was 3.4% (p = NS). The 30-days in-hospital mortality was significantly higher for emergency procedures (8.7%) than for elective surgery (4.9%) (p = 0.01). Multivariate stepwise logistic regression analysis identified concomitant diseases as independently significant risk factor. Morbidity was 36.1% (n = 91). Mean intensive care unit stay was 2.8 +/- 2.2 days vs 2.1 +/- 1.2 days for patients < 70 years (p = 0.01). Total charges per case for surgical treatment were 15% higher for elderly patients. Follow up ranged from 1 to 108 months, averaging 32 months. Long-term survival was 92%, 78% and 58% at 1, 5 and 10 years from operation. With current techniques, cardiac surgery is performed in the elderly with acceptable mortality and morbidity and with slightly increased average costs.