How safe is coronary bypass surgery in the elderly patient? Analysis of 111 patients aged 75 years or more and 2939 patients younger than 75 years undergoing coronary artery bypass grafting in a private hospital.

AIM AND

METHODS

Data from patients younger than 75 years (group I, n = 2939) and patients aged 75 years or older (group II, n = 111) who underwent isolated coronary artery bypass grafting (CABG) during a 9-year period (January 1984 to April 1993) were analyzed to determine comparative risk factors for morbidity, early and late survival, and functional outcome.

RESULTS

Traditional risk factors (hypertension, hyperlipidemia, diabetes mellitus, and smoking) were significantly more prevalent in group II. The number of patients in New York Heart Association (NYHA) functional classes 3 and 4 before surgery was also significantly higher in group II (P < 0.001), but emergency operations were equally distributed between the groups. Left main-stem stenosis was more frequent in group II patients (P < 0.01), while the number of vessels involved and pre-operative left ventricular function did not differ. Both groups underwent a mean of 4.5 grafts. Internal mammary grafts were placed in 48.4% (1422/2939) in group I and 19.8% (22/111) in group II (P < 0.001). The overall peri-operative mortality rate did not differ between the groups (2.9% for group I and 2.7% for group II). Non-fatal peri-operative myocardial infarction, ventricular arrhythmias, post-extracorporeal circulation disorientation, and temporary renal insufficiency were more prevalent in group II patients (all P < 0.05). Emergency operations and re-operative CABG increased the peri-operative mortality in both groups. The 3-year survival rate was 93% and the 3-year cardiac event-free rate was 88% for the group II patients. Most of the elderly patients (98%) were in NYHA functional classes 1 and 2 at the end of the follow-up.

CONCLUSIONS

Even if elderly patients have a slightly higher postoperative morbidity than younger patients, and an increased mortality if operated upon in an emergency, long-term survival and freedom from cardiac events are excellent and justify the continued performance of CABG in patients aged 75 years of age or more.