title: Mortality in isolated coronary artery bypass surgery in elderly patients. A retrospective analysis over 14 years.
abstract: BACKGROUND
  We aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup.
  
  
  METHODS
  From January 1999 to June 2013, 3097 patients underwent consecutive coronary artery bypass graft surgery. Patients aged over 80 years were identified. Multivariate survival analysis using Cox's regression model was performed.
  
  
  RESULTS
  We identified 99 patients older than 80 years (80-group; mean age 82±3.5 years) and 2957 younger than 80 years (control group) (mean age 64.2±9.7 years). Additive EuroSCORE was 8.4±4.8 and 4.6±4.6 (P<.001) in the 80-group vs. control group, respectively. Off-pump coronary artery bypass graft was performed in 79.6 vs. 41.6% (P<.001) in the 80-group vs. the control group. respectively. There was significantly higher 30 day-mortality in the 80-group, 11.2 vs. 3.3%, respectively (P<.001). Patients in the 80-group underwent reintervention for bleeding more frequently (9.2 vs. 2.9%; P=.001) and had a higher incidence of major cardiovascular complications than the control group (6.1 vs. 2.1%; P=.001). Independent predictors of mortality for the 80-group were: reoperation for bleeding (HR 5.7; 95% CI 1.6-19.5) and cardiovascular complications (HR 3.7; 95% CI 1.1-12.2). The mean follow-up was 6.3±4.2 years for the octogenarian group. The cumulative survival of these patients was 65.7% during the study period.
  
  
  CONCLUSIONS
  Coronary artery bypass graft is performed preferably in patients over 80 years old under the off-pump procedure. Mortality is higher in this group of patients probably related to a higher incidence of cardiovascular complications and reintervention for bleeding in the immediate postoperative period.
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: paulac_g@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Carmona García
authors.affiliation: Departamento de Anestesiología y Reanimación, Consorcio Hospital General de Valencia, Valencia, España.
authors.forename: E
authors.initials: E
authors.lastname: Mateo
authors.affiliation: Departamento de Cirugía Cardiovascular, Consorcio Hospital General de Valencia, Valencia, España.
authors.forename: F
authors.initials: F
authors.lastname: Hornero
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: M
authors.initials: M
authors.lastname: López Cantero
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: I
authors.initials: I
authors.lastname: Zarragoikoetxea
mesh_terms: D000369:Aged, 80 and over; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors
keywords: Cardiac surgery; Cirugía cardiaca; Coronary revascularization; Elderly patients; Morbimortalidad; Morbimortality; Outcomes; Paciente anciano; Revascularización coronaria