Coronary Artery Bypass Grafting in Elderly Patients Older Than 75 Years

Yoo, Dong Gon; Kim, Chong Wook; Park, Chong Bin; Choo, Suk Jung; Lee, Jae Won; Song, Meong Gun; Song, Hyun

Abstract

BACKGROUND: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. MATERIAL AND METHOD: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of 77.0+/-2.4 years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. RESULT: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was 3.3%. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below 40% were univariate predictors of overall complications. Actuarial probability of survival was 94.9%, 89.8%, and 83.5% at postoperative 1, 3 and 5 years respectively. During the follow-up period 93.3% of patients were in NYHA class I, or II and 91.1% were free from angina.
CONCLUSION
Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.