Coronary artery bypass grafting in patients over 80 years of age: a single-centre experience. 2014

Edward Pietrzyk, and Kamil Michta, and Iwona Gorczyca-Michta, and Beata Wożakowska-Kapłon

BACKGROUND Extended length of human life leads to an increased number of the elderly with coronary artery disease. Advanced age does not constitute a contra indication for surgical revascularisation. However, as reflected by the available risk scores, mortality risk associated with operating patients in the 9th decade of life is increased. OBJECTIVE To characterise patients over 80 years of age undergoing coronary artery bypass grafting (CABG) and to evaluate in-hospital mortality in the study group. METHODS We retrospectively analysed medical records of 51 patients over 80 years of age who underwent CABG in a cardiacsurgical department of a regional cardiology centre in 2008-2011. The following factors were taken into consideration: coexisting diseases, laboratory test results, echocardiographic findings, surgical data, and in-hospital mortality. EuroSCORE (European System for Cardiac Operative Risk Evaluation) I and EuroSCORE II risk scores were used for preoperative risk assessment. RESULTS The mean age in the study group was 81.7 years. Coexisting diseases included hypertension in 76.5% of patients, impaired renal function in 62.7% of patients, heart failure in 31.4% of patients, atrial fibrillation (AF) in 21.6% of patients, and diabetes mellitus in 15.7% of patients. Most patients had a history of myocardial infarction (MI). CABG was performed using cardiopulmonary bypass in 51.6% of patients. The most frequent complications were new onset AF which occurred in 41.2% of operated patients and low cardiac output syndrome which was observed in 37.3% of patients. In-hospital mortality rate among patients over 80 years of age undergoing CABG was 3.9%, lower than predicted by the logistic EuroSCORE I (9.1%) and EuroSCORE II (7.3%). Two patients died during the postoperative period, including one operated with the use of cardiopulmonary bypass. CONCLUSIONS The most common concomitant conditions in the elderly patients undergoing cardiac surgery are hypertension and impaired renal function. The majority of operated patients already suffered a MI. AF and low cardiac output syndrome are the most common postoperative complications. Among patients above 80 years of age, operative mortality risk predicted using the EuroSCORE I and EuroSCORE II may be overestimated. Patient selection for cardiac surgery must be based on individual factors, taking into account the feasibility of postoperative rehabilitation and the potential for improved survival and quality of life.

UI MeSH Term Description Entries
D008297 Male Males
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D003327 Coronary Disease An imbalance between myocardial functional requirements and the capacity of the CORONARY VESSELS to supply sufficient blood flow. It is a form of MYOCARDIAL ISCHEMIA (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. Coronary Heart Disease,Coronary Diseases,Coronary Heart Diseases,Disease, Coronary,Disease, Coronary Heart,Diseases, Coronary,Diseases, Coronary Heart,Heart Disease, Coronary,Heart Diseases, Coronary
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D001026 Coronary Artery Bypass Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. Aortocoronary Bypass,Bypass, Coronary Artery,Bypass Surgery, Coronary Artery,Coronary Artery Bypass Grafting,Coronary Artery Bypass Surgery,Aortocoronary Bypasses,Artery Bypass, Coronary,Artery Bypasses, Coronary,Bypass, Aortocoronary,Bypasses, Aortocoronary,Bypasses, Coronary Artery,Coronary Artery Bypasses
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D017052 Hospital Mortality A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. In-Hospital Mortality,Mortality, Hospital,Hospital Mortalities,In Hospital Mortalities,In Hospital Mortality,Inhospital Mortalities,Inhospital Mortality,Mortalities, In-house,Mortalities, Inhospital,Mortality, In-Hospital,Mortality, Inhospital,Hospital Mortalities, In,Hospital Mortality, In,In-Hospital Mortalities,In-house Mortalities,In-house Mortality,Mortalities, Hospital,Mortalities, In Hospital,Mortalities, In house,Mortalities, In-Hospital,Mortality, In Hospital,Mortality, In-house

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