Critical Analysis of Early and Late Outcomes After Isolated Coronary Artery Bypass Surgery in Elderly Patients (original) (raw)
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Coronary artery bypass surgery in old age group: is age itself a barrier?
JPMA. The Journal of the Pakistan Medical Association, 2009
To analyse the data retrospectively and identify risk factors that may adversely affect mortality in patients aged seventy years and older with coronary artery bypass graft (CABG). From Jan 2003 to Oct 2007, 63 consecutive patients of 70 years or older underwent primary isolated CABG on cardiopulmonary bypass (CPB) in Department of Surgery, Liaquat National Hospital. Forty one (65%) were male. The mean age was 72.7 +/- 3 years (range 70 to 81 years). Preoperatively 83% were in New York Heart Association (NYHA) class III or IV. Left main stem (LMS) lesion (> 70%) was present in 20 (32%). Renal impairment (RI) with creatinine more then 2 mg/dl was present in 9 (14%) patients. History of prior stroke was present in 7 (11%). Emergency surgery (within 48 hours after Myocardial Infarct (MI)) was performed in 33 (52%) patients. The overall hospital mortality (30 days) was 9.5%. The mean Parsonet score was 23 +/- 3, and 10 +/- 3 in those who died or survived respectively. Mean intensive ...
Impact of coronary artery bypass grafting in elderly patients
Revista Brasileira de Cirurgia Cardiovascular, 2013
Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients ≥ 65 years-old. Methods: Patients undergoing isolated on-pump CABG from December 1 st 2010 to July 31 th 2012 were divided in two groups: GE (elderly ≥ 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation-MV-and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization. Results: In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age ≥ 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors. Conclusion: This study suggests that patients ≥ 65-yearold were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.
Revista española de anestesiología y reanimación, 2017
Introduction: We aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup. Material and method: From January 1999 to June 2013, 3097 patients underwent consecutive coronary artery bypass graft surgery. Patients aged over 80 years were identified. Multivariate survival analysis using Cox's regression model was performed. Results: We identified 99 patients older than 80 years (80-group; mean age 82 ± 3.5 years) and 2957 younger than 80 years (control group) (mean age 64.2 ± 9.7 years). Additive EuroSCORE was 8.4 ± 4.8 and 4.6 ± 4.6 (p < 0.001) in the 80-group vs. control group, respectively. Off-pump coronary artery bypass graft was performed in 79.6 vs. 41.6% (p < 0.001) in the 80-group vs. the control group, respectively. There was significantly higher 30 day-mortality in the 80-group, 11.2 vs. 3.3%, respectively (p < 0.001). Patients in the 80-group underwent reintervention for bleeding more frequently (9.2 vs. 2.9%; p = 0.001) and had a higher incidence of major cardiovascular complications than the control group (6.1 vs. 2.1%; p = 0.001). Independent predictors of mortality for the 80-group were: reoperation for bleeding (HR 5.7; 95% CI 1.6-19.5) and cardiovascular complications (HR 3.7; 95% CI 1.1-12.2). The mean follow-up was 6.3 ± 4.2 years for the octogenarian group. The cumulative survival of these patients was 65.7% during the study period.
Asian Cardiovascular and Thoracic Annals, 2004
As elderly populations grow larger, cardiac surgeons are increasingly faced with the challenges of intervention in the elderly with coronary artery diseases. Elderly patients face higher surgical risks and are associated with increased mortality and morbidity rates as well as greater length of hospital stays. 1,2 However, various retrospective studies have shown that cardiac surgery performed in selected elderly patients are associated with favourable outcomes. 3-5 Thus far, there has not been any study on this subject in Malaysia. This would allow cardiac surgeons to refl ect on their past experiences and to compare themselves to their contemporaries in other countries. The objective of this retrospective study was to compare the outcome of patients aged 70 years and above who underwent isolated coronary artery bypass grafting (CABG) surgery in the National Heart Institute (NHI), Malaysia with those younger than 70 years old.
Determinants of operative mortality in octogenarians undergoing coronary bypass
The Annals of Thoracic Surgery, 1995
Background. The elderly segment of the population is increasing rapidly, and surgeons are being asked to consider patients more than 80 years old as candidates for coronary bypass. The objective of this study was to identify risk factors that may adversely affect mortality as well as analyze functional outcomes and survival in octogenarians undergoing coronary bypass. Methods. From July 1989 through February 1994, 300 consecutive patients 80 years of age and older underwent coronary artery bypass grafting. There were 176 men (58.7%) and 124 women (41.3%) with a mean age of 80.9 years (range, 80 to 99 years). Preoperatively, 274 patients (91.3%) had disabling angina, 76 (25.3%) had left main coronary stenosis greater than 50~, and 293 patients (98.3~:,) were in New York Heart Association class III or IV. Results. The overall hospital mortality was 11.0% (33/300) with an elective mortality of 9.6% (23/240), urgent mortality of 11% (5/45), and emergent mortality of 33.3% (5/15). Significant independent predictors of operative mortality were preoperative renal dysfunction, postoperative pulmonary insufficiency, postoperative renal dysfunction, use of intraaortic balloon pumping, and sternal wound infection. The actuarial survival for patients discharged from the hospital was 74.6%-5.6% (standard error of the mean) at 54 months. Conclusions. A favorable outcome may be expected when coronary artery bypass grafting is performed in patients 80 years of age or older with severe angina.
Morbidity and mortality after coronary artery bypass in octogenarians
The Annals of Thoracic Surgery, 1991
One hundred fifty seven consecutive octogenarians (mean age f standard deviation, 82.4 f 1.9 years) underwent coronary artery bypass grafting with hypothermia (mean temperature, 21.8" f 1.8"C), hyperkalemic cardioplegia, and cardiopulmonary bypass in a 9-year period. Sixty-six percent were male. Preoperatively, 115 patients (73%) were in New York Heart Association functional class IV, with the remainder being in either class 111 (23%) or class I1 (4%). Twenty percent of the patients had major complications including postoperative hemorrhage (15), sepsis (91, cerebrovascular accident (61, third-degree heart block (5), renal failure requiring dialysis (11, and pulmonary embolism (1). The 30-day or lderly patients (older than 65 years) constituted 11% of E our population in 1981, with a trend to increase yearly [l]. According to the 1980 census, 43% of all Americans will reach the age of 80 years and live for an average of 8 more years . Approximately 40% of all octogenarians have symptomatic cardiovascular disease, including 18% with ischemic heart disease [3,4]. Many of these elderly patients still enjoy productive lives, limited only by their symptomatic coronary artery disease. Recent reports indicate that coronary artery bypass grafting for select elderly individuals who otherwise are in good physical and mental health has substantially decreased mortality and morbidity, and improved quality of life [S21]. To more precisely define the preoperative characteristics and postoperative experiences of octogenarians undergoing isolated coronary artery bypass grafting, we have reviewed our recent experience.
Long-term survival of the very elderly undergoing coronary artery bypass graft surgery
Journal of the American College of Cardiology, 2003
Background. There is limited information comparing long-term survival after percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients aged 80 years and older. We studied the long-term survival of octogenarians with multivessel coronary artery disease undergoing PCI or CABG who might have been candidates for either procedure.
Operative Results of Coronary Artery Bypass surgery in elderly patients
Background: As the age of the population increases with time, more elderly patients are considered for cardiac surgery. This group of patients has the highest prevalence of cardiac disease and is more likely to have medically refractory symptoms, but they are less likely to be suitable for less invasive procedures such as coronary angioplasty. Patients and methods: Over a period of two years, from September 2008 to September 2010, 304 consecutive patients underwent isolated coronary bypass surgery (CABG) , 48 patients were 70 years of age or older (Group I) which is referred to as elderly group and 256 were below 70 years (Group II) which is referred to as younger group. Results: The mean age of 72.2 ± 2 years, their ages ranged from 70 to 85 years, 70.8% of them were males. Diabetes mellitus, hyper-tension, dyslipidemia, old cerebral infarction and renal dysfunction were more prevalent in the elderly group preoperatively. Postoperative mechanical ventilation time was significantly longer in the elderly group 34.1±8.2 hours and intensive care unit and total hospital stay were statistically significant longer in the elderly group (mean 9.3±4.6 and 15.3±6.1 days respectively). 31.3% had atrial fibrillation and 16.7% had serious ventricular arrhythmias postoperatively in elderly group that is significantly different between the two groups. Transient renal dysfunc-tion occurred in 25.0% in the elderly group with statistical significance. Cerebral stroke occurred in 1.9% with no significance. Sternal wound infection occurred in 8.3% in the elderly group without statistical significance. Overall hospital mortality occurred in 4.2% in the elderly group due to multi organ failure. There was no statistical significance between the two groups. Conclusions: Coronary artery bypass surgery can be performed safely in elderly patients with acceptable results. Careful postoperative care is required to reduce the higher rate of immediate adverse effects in this age group. Elderly patients should not be denied coronary artery bypass surgery on the bases of advanced age alone.