[Coronary heart disease and impaired left ventricular function in patients over 80 years of age--is bypass operation justified?].
Between April 1988 and February 1995, 35 patients aged 80 years or older underwent elective coronary artery bypass grafting. Concomitant aortic valve replacement was performed in eight patients. Fifteen patients with moderate to severe left ventricular dysfunction (left ventricular ejection fraction (EF) 20 to 45%) (group I) were compared to 20 patients with an EF > 45% (group II). There were no differences according to age, NYHA classification and associated diseases. Group I patients had significantly more myocardial infarctions compared to group II (1.3 +/- 1.1 vs. 0.5 +/- 0.8; p < 0.05). Also more bypass grafts per patient were used in group I (3.1 +/- 0.9 vs. 2.3 +/- 0.9; p < 0.01). No differences between the groups were observed in the postoperative course. One patient of group II died from multiorgan failure (hospital mortality 2.2%). A follow-up could be performed in 32 of 34 hospital survivors (94%) 12.0 +/- 11.2 months (1-41 months) postoperatively. There was one non-cardiac death in each group. All hospital survivors improved by at least one NYHA functional class. Actuarial survival at 3 years is 91% in both groups. In patients aged 80 years or older with or without left ventricular dysfunction coronary artery bypass surgery can be performed with an acceptable risk and a functional benefit. Thus, elective operations should be performed in this age group despite left ventricular dysfunction.
Brandt
M
M
Klinik fur Herz- und Gefasschirurgie, Christian-Albrechts-Universitat, Kiel.
Harringer
W
W
Morschheuser
T
T
Cremer
J
J
Haverich
A
A
D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000075202:Contraindications; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
Koronare Herzkrankheit und eingeschrankte linksventrikulare Funktion bei ueber 80jahrigen--ist die Bypassoperation gerechtfertigt?