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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2007 August;48(4):505-8

Copyright © 2007 EDIZIONI MINERVA MEDICA

lingua: Inglese

What factors influence the results of coronary artery bypass grafting in aged patients?

Ishikawa S. 1,2, Buxton B. F. 1, Manson N. 1, Hadj A. 1, Seevanayagam S. 1, Raman J. S. 1, Matalanis G. 1, Rosalion A. 1, Ueda K. 2

1 Department of Cardiac Surgery, Austin Hospital University of Melbourne Melbourne, Australia
2 Department of Cardiovascular Surgery Teikyo University School of Medicine, Tokyo, Japan


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Aim. Early and late results were studied in order to improve the indication for coronary artery bypass grafting (CABG) and to enhance results.
Methods. A total of 1 973 patients aged 70 years and older who had undergone isolated CABG were studied. Elective operations (EL) were performed in 1 716 patients and 257 patients underwent urgent or emergency operations (UR/EM). Patients were divided into two groups; 104 patients aged 80 years and older (Oct. Group) and 1 869 patients of septuagenarians (Sept. Group). There were no differences between the groups in the number of diseased vessels.
Results. Total operative mortality rates in the Oct. and the Sept. groups were 7% and 4%, respectively. The operative mortality of elective surgery was 4% in both groups. The operative mortality of UR/EM CABG was significantly higher in the Oct. group than in the Sept. group (21% vs 6%). Operative mortality was significantly higher in patients with preoperative poor (<49%) left ventricular ejection fraction (LVEF) than in patients with higher (>50%) LVEF (6% vs 3%). Among preoperative risk factors, diabetes mellitus and peripheral vascular disease were significant contributory factors to operative death. In the follow-up study, 70% patients of the Oct. group and 72% patients of the Sept. group survived. Preoperative number of diseased vessels and number of CABG grafts did not influence the early and late results.
Conclusion. Preoperative poor LVEF, diabetes mellitus and peripheral vascular disease were significant contributory factors to operative death. When feasible, CABG in octogenarians should be performed electively.

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