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[Coronary artery bypass grafting in patients aged 80 years or older]
1Department of Cardiovascular Surgery, Kansai Rousai Hospital, Hyogo, Japan.
Insights
Coronary artery bypass grafting (CABG) in octogenarians showed a high operative mortality, especially in emergency cases. Early intervention is recommended for elderly patients to improve outcomes and avoid age-related denial of care.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Outcomes Research
Context:
- Coronary artery bypass grafting (CABG) in elderly patients is increasing.
- A study cohort of 11 patients aged 80+ years (mean 81) undergoing CABG between 1989-1996 was analyzed.
- Most patients (82%) presented with advanced heart failure (NYHA class III/IV).
Purpose:
- To evaluate the outcomes of CABG in octogenarian patients.
- To compare the incidence of emergency surgery and its associated mortality in octogenarians versus younger patients.
- To determine if age alone should be a contraindication for CABG.
Summary:
- The study found a 27% operative mortality rate in octogenarians undergoing CABG.
- Emergency surgery was required in 36% of octogenarians, significantly higher than in younger patients (7.7%), with a 50% mortality in emergency cases.
- One elective death was associated with a concomitant arch aneurysm repair.
Impact:
- Octogenarians undergoing CABG are more likely to require emergency surgery, which carries a high mortality risk.
- The findings suggest that CABG in octogenarians should be considered earlier and not denied solely based on age.
- This highlights the need for timely surgical intervention in elderly patients with coronary artery disease.
Abstract:
Coronary artery bypass grafting (CABG) in elderly patients was increasing in recent years. Between January 1989, and December 1996, 11 patients aged 80 years or older (mean 81) underwent CABG in our hospital. Nine patients (82%) were in New York Heart Association class III or IV. Emergency surgery was required in 4 patients (36%). Incidence of emergency surgery is higher than younger patients (p < 0.005), emergency surgery required 7.7% (46/592) in younger patients. The operative mortality was 27% for these 80 years or older. It was one in elective cases and two of four (50%) in emergency cases. One operative death in elective cases was concomitant operation with arch aneurysm. More patients of CABG operations in octogenarians required emergency surgery, and emergency surgery is high operative mortality. Thus CABG in octogenarians should be performed earlier, not be denied because of age alone.