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[Myocardial revascularization interventions]
T Busch1, H Sârbu, M Friedrich
1Klinik für Thorax-, Herz- und Gefässchirurgie, Georg August Universität Göttingen, Germany. hsirbu@gwdg.de
Insights
Coronary artery bypass grafting (CABG) is a viable option for elderly patients over 70, offering symptomatic improvement with acceptable operative risk. Long-term survival rates at 5 years were 65.7%, supporting CABG for severe angina in this population.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
- The safety and efficacy of CABG in elderly patients (septuagenarians) remain a subject of debate.
- Increasing life expectancy leads to a growing number of elderly individuals requiring cardiac interventions.
Purpose of the Study:
- To evaluate the clinical outcomes of coronary artery bypass grafting (CABG) in patients aged 70 and older.
- To assess the short- and long-term results of CABG in this specific elderly cohort.
- To determine if CABG is justifiable for elderly patients with severe angina.
Main Methods:
- Retrospective analysis of 1127 patients over 70 who underwent myocardial revascularization between January 1985 and December 1996.
- Evaluation of clinical profiles, operative procedures, and postoperative outcomes (short- and long-term).
- Analysis of trends in patient demographics, risk factors, surgical techniques, and perioperative complications.
Main Results:
- The proportion of septuagenarians undergoing CABG increased significantly from 6.4% in 1985 to 21.5% in 1996.
- Preoperative conditions included 87% in NYHA-class III/IV, with increasing prevalence of renal failure, obesity, and smoking history.
- Perioperative mortality was 3.65%, hospital mortality was 9.64%, with 1-year and 5-year survival rates of 82% and 65.7%, respectively.
Conclusions:
- Coronary artery bypass grafting (CABG) can be safely performed in septuagenarian patients with acceptable operative risks.
- The majority of elderly patients experience symptomatic improvement following CABG.
- CABG is a recommended surgical option for a growing number of elderly patients suffering from severe angina.
Unlabelled:
Elective coronary artery bypass surgery (CABG) can be performed with low operative mortality. There is a controversial discussion whether short- and long-term results of CABG can justify this procedure even in elderly patients.
Material And Methods:
We retrospectively evaluated the clinical profile, operative procedure, postoperative short- and long-term results of 1127 patients over 70 years of age who underwent myocardial revascularization between January 1985 and December 1996.
Results:
Mean age was 73.9 years. In 1996, septuagenarians represented 21.5% of our operated coronary patients, when compared with 6.4% in 1985. Analysis of risk factors showed an increasing prevalence of renal failure, obesity, hyperuricemia and a history of smoking. Preoperatively 87% of our patients were in NYHA-class III and IV. The percentage of emergent operations decreased over the observed period by 10.3%. Internal mammary artery was used with increasing frequency (44.8% in 1985-92 vs. 61.5% in 1993-96). The number of simultaneous valve replacements increased, too. Postoperatively, we noted rising incidence of respiratory failure (17.1%) and neurological disorders (13.7%). On the other hand, the need for intraaortic balloon pumping and hemofiltration declined by 6.6% and 2.9%. Perioperative mortality (< or = 24 h) was 3.65%, hospital mortality (< or = 30 days) was 9.64%. Actuarial 1 year at was 82% (+/- 4.3%), and 65.7% (+/- 3.8%) at 5 years.
Conclusions:
Our data suggest that CABG can be performed in septuagenarians with an acceptable operative risk. Since the large majority of patients improve symptomatically, surgery is the recommendable option for a growing number of elderly patients suffering from severe angina.