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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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