Outcome of isolated coronary artery bypass surgery in octogenarians
N G Talwalkar1, P S Damus, L H Durban
1Department of Cardiothoracic Surgery, St. Francis Hospital, Roslyn, New York 11576, USA.
Insights
Coronary artery bypass grafting (CABG) in octogenarians showed an 8% operative mortality, but elective procedures offered good survival and symptom relief. Preoperative conditions significantly impacted outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- 100 patients aged 80+ underwent isolated coronary artery bypass grafting (CABG) between 1989-1992.
- 86% presented with severe angina (grade III or IV).
Purpose of the Study:
- To evaluate the outcomes and predictors of mortality for octogenarians undergoing isolated CABG.
- To assess the long-term survival and symptomatic relief in this elderly cohort.
Main Methods:
- Retrospective analysis of 100 octogenarian patients undergoing isolated CABG.
- Comparison of outcomes based on surgery urgency (emergency, urgent, elective) and preoperative factors.
- Multivariate logistic regression to identify independent predictors of operative and late mortality.
Main Results:
- Overall operative mortality was 8%, significantly higher than younger cohorts (2%).
- Elective CABG had zero operative mortality, while urgent/emergency cases had 13% mortality.
- Intra-aortic balloon pump use and preoperative renal dysfunction were independent predictors of operative mortality.
- Left ventricular ejection fraction (LVEF) ≤20% predicted late mortality.
- Actuarial survival at 4 years was 73%; 97% experienced no or minimal angina long-term.
Conclusions:
- Octogenarians undergoing CABG, especially those with comorbidities and severe symptoms, represent a high-risk group.
- Elective CABG before significant left ventricular dysfunction can lead to good long-term survival and symptomatic improvement.
- Careful patient selection and optimization of preoperative conditions are crucial for successful outcomes in elderly CABG patients.
Background:
Between 1989 and 1992 100 consecutive patients aged 80 or older underwent isolated coronary artery bypass grafting (CABG) in our institution. Eighty-six percent had angina grade III or IV symptoms.
Methods:
Emergency surgery was required in 31, urgent surgery in 30, and elective surgery in 39 patients. The average left ventricular ejection fractions (LVEF) in these groups were 36%, 43%, and 45% respectively. The operative mortality was 8% for these octogenarians compared to 2% in the younger cohort (p = 0.002). It was zero in elective cases and 13% (8/61) in urgent and emergency cases. It was increased by preoperative admission to coronary care unit (CCU) (p = 0.02), urgency of operation (p = 0.02), the use of intra-aortic balloon pump (IABP) (p = 0.0002), preoperative renal dysfunction (p < 0.03), and < or = 3 grafts (p < 0.04). The late mortality was increased by LVEF < or = 20% (p = 0.03) and operation from CCU (p < 0.05). On multivariate stepwise logistic regression analysis, the use of IABP (p < 0.0003) and preoperative renal dysfunction (p < 0.02) were independent predictors of operative mortality. LVEF < or = 20% was the only independent predictor (p < 0.02) of late mortality.
Results:
Actuarial survival was noted to be 87%, 80%, 77%, and 73%, respectively, at 1, 2, 3, and 4 years, with two cardiac-related late deaths. Long-term follow-up revealed that 97% of patients had no or minimal anginal symptoms.
Conclusions:
Due to increasing use of nonsurgical options, the profile of elderly referred for CABG currently involves gravely ill patients with comorbidities. CABG under elective conditions, before deterioration of left ventricular function, can achieve normal life expectancy and good symptomatic relief in octogenarians.
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