[Myocardial revascularization in aged patients: what is the surgical risk?].
There are still controversies about the surgical results of myocardial revascularization in aged population, in terms of cardiac and non-cardiac morbidity and mortality. This issue prompted us to study retrospectively 71 patients older than 75 years electively operated of coronary artery bypass grafting (CABG) from June 1990 to June 1993 (Group A). Elderly population was compared with a contemporaneous and concurrent control group of patients younger than 75 years (Group B). Patients > 75 years have been divided in successive subgroups according to the severity of coronary artery disease (3 vessel disease 67.7%, 2 vessel disease 26.7%, 1 vessel disease 5.6%), echocardiographic ejection fraction (EF > 50%: 40.8%; 50-30%: 42.2%; < 30%: 16.9%) and preoperative risk factors. Left internal thoracic artery (LITA) utilization rate was 97.1% in Group B and 57.7% in Group A (p < 0.001). Cardiopulmonary bypass circulation, aortic cross-clamping time and number of coronary anastomoses were similar in the 2 groups (2.87 +/- 0.9 versus 2.8 +/- 0.8, NS). Operative mortality rate of aged population was 4.2% while no patient of Group B died (NS). Concerning the cardiac morbidity, there were no significantly differences between the 2 groups: myocardial infarction occurred in 3 patients of Group B (4.2%) and in 5 patients of Group A (7%; NS). Atrioventricular block was also similar in the 2 groups. Non-cardiac complications occurred more frequently in the aged population group: neurologic complications in 11.2% versus 1.4% (p < 0.04), renal insufficiency in 12.6% versus 1.4% (p < 0.03) and respiratory failure in 9.8% versus 1.4% (p = 0.06). (ABSTRACT TRUNCATED AT 250 WORDS)
Cattedra di Cardiochirurgia, Università degli Studi, Centro Cardiologico Fondazione I Monzino, Milano.
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Pompilio
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Antona
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Musumeci
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Arena
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Dainese
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Polvani
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Porqueddu
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Biglioli
D000367:Age Factors; D000368:Aged; D000075202:Contraindications; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000401:mortality; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
Rivascolarizzazione miocardica nel paziente anziano: quale rischio operatorio?