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[Coronary artery bypass grafting with arterial grafts in the elderly patients]
1Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan.
Insights
Coronary artery bypass surgery in patients 75 and older shows favorable outcomes, especially with arterial grafts. This study compared outcomes in elderly patients undergoing coronary artery bypass grafting (CABG) to a control group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Anesthesiology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- The safety and efficacy of CABG in elderly patients (75 years and over) require specific consideration.
- Arterial grafts are increasingly recognized for their long-term patency compared to venous grafts.
Purpose of the Study:
- To evaluate the outcomes of coronary artery bypass surgery in patients aged 75 years and over.
- To compare surgical parameters and outcomes between elderly patients and a younger control group.
- To assess the impact of arterial graft utilization in this elderly cohort.
Main Methods:
- Retrospective analysis of 106 consecutive patients aged 75+ undergoing CABG.
- Comparison with a control group of 287 patients who underwent CABG in 1996.
- Analysis of graft types (LITA, SVG, GEA, RITA, IEA, RA), operative times, and outcomes.
Main Results:
- Elderly patients showed significantly higher use of saphenous vein grafts (SVG) and lower use of radial artery (RA) grafts compared to the control group.
- Arterial graft utilization was 1.9 in the aged group versus 2.5 in the control group (p < 0.01).
- No operative deaths occurred in elective procedures; 4.9% mortality was observed in emergent operations.
Conclusions:
- Coronary artery bypass surgery can achieve favorable outcomes in patients aged 75 and over.
- The use of arterial grafts in elderly patients undergoing CABG is associated with positive results.
- Careful patient selection and surgical strategy are crucial for successful outcomes in geriatric cardiac surgery.
Abstract:
One hundred six consecutive patients aged 75 years and over (mean age 77.1, 75-84) underwent coronary artery bypass. Controlled group is 287 patients undergoing CABG in 1996. The number of bypass graft, arterial graft, Ao-cross clamp time, CPB time, operation time in aged group and controlled group were as follows 3.3 and 3.3, 1.9 and 2.5 (p < 0.01), 106 and 104, 333 and 328. The number of anastomose per patients with LITA, SVG, GEA, RITA, IEA, RA, as follows 1.0 and 1.0, 1.5 and 0.5, 0.6 and 0.5, 0.1 and 0.14, 0.03 and 0.03, 0.2 and 3.3 SVG were used significantly high and RA were used low in aged group. Sequential bypass were under went 30.1% in aged group and 35.5% in controlled group. There was no operative death in elective operation, 5 (4.9%) was died in emergent operation. A favorable outcome may be expected when coronary bypass surgery with arterial graft is performed in 75 years and over aged group.