title: Early and long-term results of minimally invasive coronary artery bypass grafting in elderly patients.
abstract: BACKGROUND
  Standard (conventional) coronary artery bypass grafting (CABG) is an invasive procedure which requires full median sternotomy and is performed with extracorporeal circulation (ECC), which can lead to serious complications.
  
  
  OBJECTIVE
  To analyse the results of minimally invasive CABG (MIDCAB) in elderly patients.
  
  
  METHODS
  Between 1999 and 2007, a total of 698 MIDCAB procedures were performed at our institution. We present the data on 235 elderly (≥ 70 years) patients (160 males, mean age 74.5 ± 3.2 years, range: 70-83 years) who were consecutively operated on in this period. Early mortality, post-operative complications, long-term survival, impact of multivessel disease (MVD) and hybrid coronary artery revascularisation on total mortality were analysed. Logistic EuroSCORE was 8.7%. The survival of 235 elderly patients was compared to the survival of the remaining 463 MIDCAB patients aged < 70 years (including risk factors for total mortality).
  
  
  RESULTS
  The 30-day mortality was 2.5% (six patients). During follow-up, two patients underwent coronary reoperation and percutaneous coronary intervention (PCI) was performed in 16 patients. Kaplan-Meier analysis revealed a 1.5-year survival of 89.8% (95% CI 85.9-93.7%) and five-year survival of 79.7% (95% CI 74.3-85%). Compared to single vessel disease (SVD) patients, the MVD patients had significantly higher total mortality (p = 0.0038). Our study revealed MVD (p = 0.0016) and male sex (p = 0.0091) as important independent factors of total mortality in this group of elderly patients. The difference in total mortality between non-hybrid vs hybrid MIDCABs was not significant (p = 0.63). The younger MIDCAB patients (< 70 years) have a tendency to better survival, but the difference did not achieve statistical significance (p = 0.088). They had the same independent factors of total mortality as in the elderly group: MVD (p = 0.0001) and male sex (p = 0.0059).
  
  
  CONCLUSIONS
  The MIDCAB is a reasonable option for elderly patients with SVD, and in selected patients with MVD. The decision to perform MIDCAB rather than PCI in these high risk patients should always be very carefully considered in conjunction with the interventional cardiologist.
authors: Department of Cardiac Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic. vojacek.jan@fnhk.cz
authors: Zdenek
authors: Z
authors: Sorm
authors: Jan
authors: J
authors: Harrer
authors: Martin
authors: M
authors: Voborník
authors: Eva
authors: E
authors: Cermáková
authors: Jan
authors: J
authors: Vojácek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome