Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass (original) (raw)
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Coronary artery bypass surgery in patients aged 80 years or older
The American Journal of Cardiology, 1987
tients aged 80 years or older underwent coronary artery bypass grafting (CABG) operations. lhese patients had a higher InGidence of severe left main coronary artery narrowing (p <O.OOOl), 3-vessel coronary artery disease (p <0.05) and moderate to severe left ventricular dystunction (p X0.05) than patients in the Coronary Artery Surgery Study registry older than 65 years. Cf. 14 patients undergotng elective simple CABG procedures, none died; ot 19 elective cases overall, 2 patients died (11%). Three ot 4 patients undergoing emergency procedures (75%) and 4 ot 6 patients (67%) requiring I n the early stages of cardiac surgery, advanced age was considered a relative contraindication. Over the last decade many reports have been published supporting the notion of cardiac surgery in the elderly.'-l7 Initially, these reports focused on patients aged 65 years or older; however, several reports document excellent results in cohorts of septuagenarians.1,3,5-8,10,11,13,14.16 To determine the advisability of coronary artery bypass grafting (CABG) in octogenarian patients, we reviewed the course of our operative patients 80 years and older with regard to morbidity and mortality rates and survivor longevity and function. Methods Between August 1980 and January 1,1986, a total of 4,743 patients underwent cardiac surgery at our institution. Of these patients, 23 (0.5%) were 80 years or
Isolated coronary artery bypass grafting in one hundred octogenarian patients
The Journal of Thoracic and Cardiovascular Surgery, 1993
respectively. Unlike Ko and associates, however, we found that 12 of the 14 hospital deaths were attributable to cardiac causes. There were 29 late deaths, but the 5-year actuarial survival was 73.1%. Thus even urgent cardiac procedures can be undertaken in octogenarians with acceptable risks. We established a clear benefit for surgical intervention; from 74.5% New York Heart Association class IV and 25.5% New York Heart Association class III preoperatively, after their operations 65% of patients were in class I/II and 25% were in class III. There was, however, a significant rate of morbidity: 81 patients had complications, and hospital stay averaged 18.8 days for survivors. This high complication rate is similar to that in other reports>" and may reflect the proportion of urgent cases in our series. Ko and colleagues reported three deaths in four patients who underwent exploration for mediastinal bleeding. In our series 23 patients underwent reexploration for bleeding and 6 died, reflecting both the need for meticulous hemostasis and perhaps the benefit of early reexploration. Our patients had no intraabdominal complications but 12 patients had new renal failure and, despite the fact that only 4 needed dialysis, 11 of the 12 were dead within 50 months after the operation. Nevertheless, 12 of 14 early deaths were directly attributable to cardiac causes; this suggests that early mortality is usually due to cardiac failure but that other organ system failure or insults manifest themselves in late results. Even in the face of multisystem disease, cardiac surgeons should be able to operate on octogenarians with good results. Comprehensive patient assessment, proper selection, preoperative preparation, meticulous surgical technique, and careful postoperative care are all critical in limiting the increased rates of morbidity and mortality in this group. Our results in urgent/emergency cases (many in an era when myocardial protection and conduct of cardiac surgical procedures was not as advanced as it is today) are in accord with those of Ko 1 and Tsai 4 and their associates. We believe that Bashour and colleagues-are wrong when they conclude that "a generally conservative approach is recommended for octogenarian patients." The increased risks associated with deteriorating ventricular function as well as the benefits of surgery in terms of survival and the quality of life (measured objectively and subjectively) have now been clearly demonstrated for octogenarians. Therefore, despite the achievement of acceptable results in a large group of unselected urgent and emergency cases, we need to educate cardiologists to investigate and refer elderly patients timeously, instead of adopting a despairing conservative attitude that may become a self-fulfilling prophecy after delayed and more risky surgical procedures.
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
Background and Methods: Indications for coronary artery bypass grafting (CABG) are expanding. We retrospectively analyzed the results of isolated CABG performed at Shin-Tokyo Hospital between January 1, 1992, and August 31, 2000. Preoperative, perioperative, and follow-up data of patients 80 years of age or older (group E, n=55) were collected and compared with those of patients between 75 and 79 years of age (group Y, n=197). Results: Patient demographics were not significantly different except there was a greater incidence of co-existing valvular disease in group E. CABG was completed without any significant differences, except fewer distal anastomoses and more frequent off-pump CABG were performed in group E than in group Y. The in-hospital mortality rates of group E and Y were 1.8% and 2.5% (p=NS), respectively. The postoperative recovery (intubation time, ICU stay, and postoperative hospital stay) of group E was similar to group Y. During the mean follow-up of 2.6 years (maximum 8.4 years), the actuarial 3-year survival of groups E and Y was 84.5% and 94.9% (p=NS), respectively, excluding in-hospital mortality. The actuarial 3-year cardiac event-free rates were 100% in group E and 88.4% in group Y (p=NS). Conclusion: CABG for octogenarians can be performed safely. Once adequate revascularization was established, the long-term cardiac events were similar to those of the younger patients. (Ann Thorac Cardiovasc Surg 2001; 7: 282-91)
Coronary arteries bypass grafting surgery in elderly patients
The journal of Tehran Heart Center, 2013
The incidence of coronary artery bypass grafting surgery (CABG) in elderly patients has been increasing. There are contradictory reports on the early outcome of elderly coronary artery patients as compared with their young counterparts. We designed this retrospective study to address this issue. We retrospectively analyzed the results of 1489 on-pump CABG cases performed at our hospital during a 4.5-year period. Perioperative data such as demographic, medical, clinical, operative, and postoperative variables were collected and compared between patients 70 years old or younger (Group A, n = 1164) and patients above 70 years of age (Group B, n = 325). Statistical analysis was performed using the t-test for the continuous and the X(2) tests for the categorical variables. Significant variables according to the univariate analysis (X(2) and t-test) were further analyzed using multivariate logistic regression analysis. The variables of weight (P value < 0.001), preoperative PO2 (P valu...
European Journal of Cardio-Thoracic Surgery, 2002
Objective: To investigate the influence of age and modern techniques of coronary artery bypass grafting with or without cardiopulmonary bypass on early and mid-term mortality and morbidity in a consecutive series of elderly patients. Methods: From April 1996 to December 2000, data of 3842 patients undergoing coronary revascularisation were prospectively entered into a database. Data were extracted for 990 patients older than 70 years: (A) 70-74 years, (n ¼ 659); (B) 75 or more years, (n ¼ 331). Results: A total of 990 elderly patients ($70 years) underwent coronary revascularisation, 219 (22.1%) with off-pump surgery. Elderly patients were more likely to have higher CCS, NYHA and EuroScores, history of previous MI, unstable angina, renal dysfunction, left main stem disease $50%, and to be urgent. However, they were less likely to be overweight. In-hospital mortality, occurrence of re-intubation, renal dysfunction, and hospital stay were significantly higher in this elderly group. Overall, the distribution of mortality was doubled in the female gender although this was not statistically significant. Patients undergoing on-pump surgery had lower EuroScore, were less likely to be .75 years of age, likely to have obesity or hypercholesterolaemia, or to have suffered a previous cerebro-vascular accident. However, they had more extensive coronary disease, were more likely to have unstable angina, and received more grafts than those undergoing off-pump surgery. After adjustment for prognostic variables, off-pump surgery was found to be associated with reduced inotropic use, intra-operative arrhythmias, blood loss and transfusion requirement when compared to on-pump coronary surgery (point estimates of odd ratios, 0.26-0.87) (all P , 0:05). Mid-term mortality or cardiac-related events were similar in the two groups. Conclusions: Early but not mid-term mortality is higher in patients aged 75 or more years when compared with those aged 70-74 years. Off-pump coronary artery bypass surgery is safe and effective in the elderly population. q
Coronary artery bypass grafting in octogenarians: long-term results
2010
Objective Coronary artery bypass grafting (CABG) is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between January 2002 and December 2011, a total of 101 consecutive patients at an age of 80 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ± 2.27 years. Sixty-four (63.4%) were males and 37 (36.6%) were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit (ICU) stay, inotropic support, intra aortic balloon pulsation application, amount of erythrocyte transfusion and fresh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass (CPB) was found to be an independent predictor of mortality (OR: 1.18, 95% CI 1.01−1.38, P = 0.034). The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.
The Thoracic and Cardiovascular Surgeon, 1992
Isolated coronary artery bypass grafting in patients seventy years of age and older Early and late results Increasing longevity makes the consideration of coronary bypass common in elderly patients. Seventy-jive patients 70 years of age or older undergoing coronary artery bypass grafting (CABG) for angina pectoris were compared to a control group of 75 patients under 70 years of age. The groups were matched for male:female ratio (46:29), previous infarction (28/75), unstable angina (27/75), and the requirement for preoperative intra-aortic balloon pumping (7/75). Patients under 70 years of age had an average preoperative New York Heart Association (NYHA) class of 3.0 ± 0.6 (SEM) and an average left ventricular end-diastolic pressure of 15.5 ± 0.8 mm Hg, compared to 3.3 ± 0.6 and 12.9 ± 1.1 mm Hg, respectively, for the older group. Average grafts per patient were 2.7 ± 0.8 in the younger group and 2.8 ± 0.1 in the older group. Overall operative mortality for patients under 70 was 4% (3/75) versus 12% (9/75) (p = 0.06) for patients 70 and older. The incidence of chronic stable angina was 2% (1/48) versus 6% (3/48) (p = 0.30). Perioperative infarctions occurred in 7% of those under 70 and 5% of those 70 or older (p = 0.54). Those under 70 averaged 13.8 ± 0.6 postoperative hospital days versus 18.4 ± 1.2 hospital days for the older group (p < 0.05). Follow-up ranged from 2 to 94 months, averaging 22 months for patients under 70 and 24 months for those 70 or older. Late cardiac mortality rates were 4% (3/70) in the younger patients and 3% (2/66) in the older patients (p = 0.53). Current NYHA class was 1.3 ± 0.7 for those under 70, with 9% reporting angina, and 1.4 ± 0.7 for those who were 70 or older, with 6% reporting angina. CABG can be performed with acceptable risk in older patients and leads to encouraging symptomatic improvement and late survival.
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.