Morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery.
OBJECTIVE
Due to the constantly improving results of surgical revascularization for coronary heart disease even the elderly patients are offered more frequently this type of treatment. Since older age is a harbinger of reduced vital capacity and increased morbidity the results of coronary artery bypass grafting (CABG) in elderly as well as long-term benefit deserve a careful examination.


METHODS
1475 isolated CABG procedures performed between 1995 and 1997 in a university hospital cardiac surgery unit, divided in group I (age below 70, n = 1324) and group II (age 70 and over, n = 151). A retrospective analysis of pre-operative, peri-operative and post-operative data.


RESULTS
Significant differences (lower BMI and BSA, advanced NYHA and CCS stage, higher prevalence of diabetes, renal dysfunction and extracardial atherosclerotic lesions) were found in elderly. CABG was performed in both groups with no differences in technique of procedure (only slightly longer duration of CPB in group II). However, there was markedly higher mortality (2.3 vs. 7.3%, p < 0.005), incidence of NearMiss+ (18.4 vs. 36.4%, p < 0.005) and post-operative morbidity (34.6 vs. 56.3%, p < 0.005) in the older group, which was also expressed in a longer ICU stay and postoperative hospitalization.


CONCLUSIONS
Coronary revascularization can be performed in elderly with higher but still acceptable risk. Higher mortality and associated morbidity is caused by higher preoperative prevalence of known risk factors as well as generally reduced vital capacity. Surgical procedure should not be denied to elderly population because of the age alone but a careful evaluation of an individual patient is required.
Zácek
P
P
Department of Cardiac Surgery, University Teaching Hospital, Hradec Králové. zacek@fnhk.cz
Dominik
J
J
Harrer
J
J
Lonský
V
V
Mand'ák
J
J
Kunes
P
P
Solar
M
M
D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate