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[Coronary artery bypass surgery in patients aged 75 years and older]
S Hamanaka1, T Hata, Y Tsushima
1Department of Cardiovascular Surgery, Cardiovascular Center Sakakibara Hospital, Okayama, Japan.
Insights
Coronary artery bypass grafting (CABG) in patients over 75 years old shows low hospital mortality and significant symptomatic benefit. Advanced age should not be a reason to deny elderly patients this life-improving cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Coronary artery bypass grafting (CABG) is increasingly performed in elderly patients.
- Elderly patients undergoing CABG face higher complication and mortality rates compared to younger individuals.
Purpose of the Study:
- To evaluate the outcomes of CABG in patients aged 75 years and older.
- To compare CABG results in very elderly (80-86 years) and elderly (75-79 years) groups with younger patients.
Main Methods:
- Retrospective analysis of 604 CABG patients from January 1989 to February 1997.
- Comparison of three groups: 80-86 years (Group A, n=20), 75-79 years (Group B, n=57), and younger patients (Group C, n=100).
- Analysis of preoperative factors, graft types, and outcomes including hospital mortality and symptomatic improvement.
Main Results:
- Group A showed higher rates of emergency operations (45%) and intra-aortic balloon pumping (20%).
- Lower rates of no-blood-transfusion procedures were observed in elderly groups (A: 20%, B: 18%) compared to Group C (82%).
- Elderly groups received fewer grafts per patient and fewer arterial grafts compared to younger patients, yet experienced low hospital mortality (A: 0%, B: 0.18%) and significant symptomatic benefits.
Conclusions:
- CABG can be safely performed in patients over 75 years old.
- Elderly patients undergoing CABG achieve acceptable mortality rates and improved quality of life.
- Age alone should not be a contraindication for CABG in elderly individuals.
Abstract:
Coronary artery bypass grafting (CABG) has been performed for elderly patients with increasing frequency. Several studies have shown that the rate of complications and mortality in elderly patients are higher than in younger ones. This report presents results of CABG in patients over 75 years old. From January 1989 to February 1997, 604 patients underwent CABG, of whom 20 patients (3.3%) were 80-86 years old (group A) and 57 patients (9.4%) were 75-79 years old (group B). We compared these two groups with 100 younger patients (group C). Preoperative use of intraaortic balloon pumping and the emergency operation were more frequent in patients of group A (emergency 45%, IABP 20%). And the proportion of the no blood transfusion procedures was lower in elderly patients (group A 20%, group B 18%, group C 82%). The number of grafts per patient (group A 2.45 +/- 0.62, group B 2.2 +/- 0.6, group C 3.2 +/- 0.6) and the number of arterial grafts (group A 1.25 +/- 0.62, group B 1.25 +/- 0.66, group C 2.1 +/- 0.53) were different between the groups. But CABG in elderly patients was performed with low hospital mortality (group A 0%, group B 0.18%) and significant symptomatic benefit. We conclude that CABG can be performed in elderly patients with acceptable mortality and acceptable quality of life, so patients should not denied operation because of an advanced age.