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The Journal of Cardiovascular Surgery 1999 June;40(3):333-8

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

The influ­ence of age on the out­come of pri­mary cor­o­nary ­artery ­bypass graft­ing

Chris­tenson J. T., Simo­net F., Schmu­zi­ger M.

From the Department of Cardiovascular Surgery Columbia Hôpital de la Tour Meyrin-Geneva, Switzerland


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Background. With the ­steady ­increase in the num­ber of eld­er­ly ­patients requir­ing cor­o­nary ­artery ­bypass graft­ing (­CABG), scep­ti­cism ­still ­exists as to wheth­er ­this oper­atio­ni is jus­ti­fied in old­er ­patients or not, and wheth­er ­there is an ­upper age lim­it. The aim of ­this ­study was to exam­ine the ­effects of increas­ing age on the out­come of ­CABG.
Methods. A ret­ro­spec­tive ­review was per­formed on 2127 con­sec­u­tive ­patients under­go­ing pri­mary ­CABG ­from January 1990 ­through June 1996. The ­patients ­were arbi­trar­i­ly divid­ed ­into age ­groups: 69 ­years or ­less (n=1607), 70-75 ­years (n=371), 76-80 ­years (n=129) and old­er ­than 80 ­years (n=20). Mortality, mor­bid­ity and ­long-­term sur­vi­val for ­each ­group was com­pared.
Results. The ­groups con­tain­ing the eld­er­ly ­patients ­showed an ­over-rep­re­sen­ta­tion of wom­en, as ­well as a high­er fre­quen­cy of arte­ri­al hyper­ten­sion, hyper­lip­i­de­mia, pre­vi­ous infarc­tion and dia­betes. More ­patients, ­amongst the eld­er­ly, had ­unstable angi­na and dif­fuse cor­o­nary dis­ease requir­ing ­urgent sur­gery and cor­o­nary throm­ben­dar­te­rec­to­my com­pared to ­those <70 ­years. Hospital mor­tal­ity did not dif­fer ­between the ­groups, 1.8, 3.0, 2.3 and 5.0%. There was an ­increased inci­dence of low post­op­er­a­tive car­diac out­put and a high­er inci­dence of gas­tro-intes­ti­nal com­pli­ca­tions ­amongst the eld­er­ly. The 5-­year sur­vi­val was 92.2% (<70 ­years), 87.0% (70-75 ­years) and 86.3% (76-80 ­years) and the car­diac ­event-­free sur­vi­val was 87.5% (<70 ­years), 78.4% (70-75 ­years) and 80.8% (76-80 ­years) at 5 ­years.
Conclusions. An accept­able ear­ly mor­tal­ity and medi­um-­term sur­vi­val (5 ­years) togeth­er ­with excel­lent func­tion­al medi­um-­term ­results sup­port the jus­tifi­ca­tion of pri­mary ­CABG in old­er ­patients irre­spec­tive of age.

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