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The Journal of Cardiovascular Surgery 1999 Febbraio;40(1):83-91

lingua: Inglese

Cor­o­nary ­artery ­bypass pro­ce­dures in sep­tu­age­nar­ians are jus­ti­fied. Short and ­long-­term ­results

Busch Th., Friedrich M., Sirbu H., Stamm Ch., Zenker D., Dauchau H.

From the Depart­ment of Tho­racic and Car­di­o­vas­cular Sur­gery, Georg-­August Uni­ver­sity, ­Göttingen, Ger­many


Back­ground. Elec­tive cor­o­nary ­artery ­bypass sur­gery can be per­formed ­with low oper­a­tive mor­tality. ­There is a con­tro­ver­sial dis­cus­sion ­whether ­short-­term and ­long-­term ­results of ­CABG jus­tify ­this pro­ce­dure in eld­erly ­patients.
­Methods. To add to ­this dis­cus­sion, we eval­u­ated ret­ro­spec­tively, the clin­ical pro­file, oper­a­tive tech­nique, ­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 of the ­cohort was 73.9 ­years and it ­rose con­tin­u­ously. In 1996, sep­tu­age­nar­ians rep­re­sented 21.5% of our cor­o­nary ­patients, in com­par­ison to 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 or IV, and ­thus oper­ated to ­relieve ­severe symp­toms. The per­centage of emer­gent oper­a­tions ­decreased ­over the ­observed ­period by 10.3%. The ­internal mam­mary ­artery was ­used ­with ­rising fre­quency (44.8% in 1985-1992 vs 61.5% in 1993-1996). The ­number of simul­ta­neous ­valve replace­ments ­increased, too. Post­op­er­a­tively, we ­noted a ­rising inci­dence of res­pir­a­tory ­failure (17.1%) and neu­ro­log­ical dis­or­ders (13.7%). On the ­other ­hand, the ­need for intra­-aortic bal­loon ­pumping and hemo­fil­tra­tion ­declined by 6.6% and 2.9%, respec­tively. Per­i­op­er­a­tive mor­tality (≤24 hrs) was 3.65%, hos­pital mor­tality (≤30 ­days) was 9.64%. The actu­arial sur­vival (stan­dard ­error) at 1 ­year was 82% (±4.3%), and 65.7% (±3.8%) at 5 ­years.
Con­clu­sions. Our ­data sug­gest ­that cor­o­nary ­artery ­bypass ­grafting can be per­formed in sep­tu­age­nar­ians at an accept­able ­risk. ­Since the ­large ­majority of ­patients ­improve symp­to­mat­i­cally, sur­gery is a rec­om­mend­able ­option for a ­growing ­number of eld­erly ­patients suf­fering ­from ­severe ­angina.

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