[Surgery of the coronary vessels in the elderly].
OBJECTIVE
The rising numbers of elderly patients with occlusive coronary artery disease amenable to surgical correction prompted us to reevaluate the benefits and risks of aorto-coronary bypass in these patients.


METHODS
In the five-year period, from June 1980 through May 1985, 293 patients 65 years old and older (mean 69.1 years) and with a male: female ratio of 4:1, were subjected to aorto-coronary bypass.


RESULTS
Operative mortality was 4.8%, higher amongst 71 patients who had endarterectomy (8.5%) and those who had concomitant valve replacement (7.7%), but lower (2.5%) in the 99 patients who had only saphenous vein grafts (p less than 0.05). The survivors were followed for three to eight years (mean 4.9 years), with a cumulative follow-up of 1.005 patient-years. Late mortality was 4.6%/patient-year (46 patients), higher in patients with valve replacement (6.0%/patients-year; p less than 0.05), but lower in patients with internal mammary artery grafts (2.6%/patient-year). Late mortality was cardiac-related in 45.6% of the cases (21/46). Two patients were reoperated upon (0.2%/patient-year) and other two had percutaneous balloon angioplasty. Thirty six patients (12.9%) had recurrent angina during the period of follow-up, but the incidence was 20% in those who had only vein grafts (p = NS). Nine patients had myocardial infarction (0.9%/patient-year) of which six (67%) were fatal. In actuarial terms, 80% of the patients survived and 95% were free from myocardial infarction after six years.


CONCLUSIONS
As in younger patients, coronary surgery in the elderly patient leads to improved life quality and survival. This study appears to confirm the superiority of internal mammary artery grafts also in the old patient.
Antunes
M J
MJ
Fernandes
L E
LE
Ferrão
J M
JM
D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*
Cirurgia das coronárias na 3.a idade.