Coronary artery bypass grafting in the octogenarian

Utley, Joe R.; Leyland, Steven A.

doi:10.1016/s0022-5223(19)36658-9

Cited by 39 publications

(7 citation statements)

References 12 publications

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“…3). This is comparable to previou sly reported survival rat es (36,(46)(47)(48). Dne might argue that pati ents older than80 yearswho are fitenough for open heart surgerymay be otherwise hea lthier than a mat ched population and therefore an improved survival cannot be assumed (51), butit was clearly dem onst rated by our dat a that pati ents after heart surge ry are restored at least to a level of survival of the general population of the same age.…”

Section: Recurrenceof Angina Pectoris Was Observed In 4 Patients Drusupporting

confidence: 85%

Heart Surgery in Patients Aged Eighty Years and Above: Determinants of Morbidity and Mortality

Deiwick¹,

Tandler²,

Möllhoff³

et al. 1997

Thorac cardiovasc Surg

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Escalating medical costs, limitation of resources and the necessity to provide cost-effective medical care have created a need for systematic risk stratification and cost-benefit analyses in the background of an ongoing discussion. Results of heart surgery in octogenarians have been evaluated in a prospective single-center, study since 1990. 101 consecutive patients (55/ 101 = 54.5% female) aged 80 years and above (median: 81 years; interquartile range [IQR]: 80.0-82.5, total range [TR]: 80-92 years) undergoing open heart surgery at our institution between January 1990 and March 1996 were included into this prospective study. Prior to surgery, most patients were severely symptomatic being in functional NYHA classes either III (56.4%) or IV (31.7%). 61/101 (60.4%) patients underwent isolated coronary artery bypass grafting (CABG), 23 (22.8%) had aortic valve replacement (AVR), 14 patients (13.9%) had CABG combined with AVR or double valve replacement and 3 (3.0%) had mitral valve repair. Follow-up (median: 23.0 months. IQR: 10.5-39.0, TR: 1-72) was focused on long-term morbidity and quality of life. The impact of preoperative and operative risk factors on morbidity and mortality was determined by uni- and multivariate statistical analysis. The 30-days overall mortality in this study was 7.9%. The postoperative course was uneventful for 27 (26.7%) of our patients. Univariate risk factors of postoperative mortality were: left main stem disease (p < or = 0.044), ejection fraction < 45% (p < or = 0.006), preoperative intensive care unit (ICU) (p < or = 0.002), urgent or emergency operation (p < or = 0.034). The only independent predictor of operative mortality was preoperative ICU-stay (p < or = 0.008). Significant risk factors for the number of postoperative complications in the multivariate analysis were: prior stroke (p < or = 0.04), diabetes mellitus (p < or = 0.02), New York Heart Association (NYHA) class IV symptoms (p < or = 0.002) and prolonged cross-clamping time (p < or = 0.001). Mean postoperative length of stay in the ICU was 3.9 +/- 3.9 days. Late morbidity was not related to postoperative complications. Cumulative survival was 87.9%, 79.5% and 72.9% at one, two or five years, respectively. After hospital discharge, 67/93 patients (82.8%) were in NYHA functional class I or II. Cardiac surgery in very elderly patients can be performed with acceptable operative risk and a favorable long-term outcome. The individual patient risk-profile including significant co-morbid conditions and severity of the heart disease predicts not only survival but the extent of perioperative morbidity.

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Section: Recurrenceof Angina Pectoris Was Observed In 4 Patients Drusupporting

confidence: 85%

Heart Surgery in Patients Aged Eighty Years and Above: Determinants of Morbidity and Mortality

Deiwick¹,

Tandler²,

Möllhoff³

et al. 1997

Thorac cardiovasc Surg

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“…Increased incidences of infectious and neurologic events have been observed in several studies. [35][36][37][38] From these studies, it became clear that cardiac surgery can be performed successfully in the elderly but that morbidity was increased, particularly in those with coexisting illnesses and urgent or emergent operative status.…”

Section: Discussion Anddquo;mentioning

confidence: 99%

Coronary Artery Bypass Surgery in Nonagenarians

et al. 1999

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As the number of nonagenarians increases yearly in the United States, surgeons will be asked more often to evaluate the possibility of intervention for coronary artery disease in this age group. The purpose of this study is to document experience with patients 90 years of age or older in order to determine whether coronary artery bypass grafting surgery is justified. Eleven patients aged 90 years or more underwent cardiac surgery for symptomatic coronary artery disease refractory to medical management between January 1, 1987, and December 31, 1996. All patients were in NYHA Class IV preoperatively. In-hospital death occurred in two patients (18%). In-hospital morbidity occurred in all patients (100%) including seven cardiac, four respiratory, two neurologic, and one infectious. All survivors left the hospital symptomatically improved. The mean length of stay was 28 days. Four patients died at a mean of 2 years and 2 months postoperatively. Five patients remain alive at a mean of 1 year and 7 months. Coronary artery bypass grafting in nonagenarians can be performed successfully in selected cases. However, increased mortality and morbidity rates and length of stay are associated with this age group. For survivors, the quality of life is improved and the projected life expectancy restored.

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“…Rates of these complications vary among published reports, with an incidence as high as 24%. [1][2][3][4][5][6][7] More recently, reports have shown a decrease in the morbidity of wound complication by harvesting the saphenous vein endoscopically. [8][9][10][11] However, there is no consensus because other studies demonstrating no difference between conventional and endoscopic saphenous harvesting have also been reported.…”

mentioning

confidence: 99%