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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 209-217, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NW Salomon, US Page, JC Bigelow, AH Krause, JE Okies and MT Metzdorff
A consecutive series of 7104 patients undergoing isolated coronary artery
bypass grafting during an 18-year period (1971 to 1988) included 469
patients older than 75 years. Results were analyzed to determine
comparative risk factors for morbidity, early and late survival, and
functional outcome. Patients younger than 75 years (group I) and patients
older than 75 years (group II) were identical for ejection fraction and
standard hemodynamic indices. Mean number of grafts and crossclamp time
were greater for group II patients (p less than 0.01). Mean age of group I
was 58.6 years and group II, 77.6 years (p less than 0.01). Women composed
19.7% (1308/6635) of group I and 36.2% (170/469) of group II patients (p
less than 0.05). Mammary grafts were placed in 57.7% (3830/6635) of group I
and 41.6% (195/469) of group II patients (p less than 0.05). Overall
perioperative mortality rate was 2.1% for group I and 6.8% for group II (p
less than 0.05). Perioperative myocardial infarction rate was similar for
the two groups. Ventricular and supraventricular arrhythmias, renal
insufficiency, neurologic complications, prolonged ventilatory support,
increased hospital cost, and prolonged hospitalization were significantly
more prevalent (all p less than 0.05) in patients older than 75 years. Five
and 10 years postoperatively, there were no significant differences between
groups I and II with regard to event- free status including angina,
myocardial infarction, and reoperation. The 5-year survival rate was 92%
for group I and 80% for group II (p less than 0.05), similar to that of
age-matched control subjects. The significantly increased potential for
complications and expense of coronary bypass in patients over 75 years of
age mandates judicious patient selection and preoperative counseling.
Despite a significantly increased early mortality and an anticipated
decreased long-term survival paralleling normal life table survival curves,
good intermediate functional improvement can be realized in patients older
than 75 years, comparable with that expected in a much younger age group.
ARTICLES
Coronary artery bypass grafting in elderly patients. Comparative results in a consecutive series of 469 patients older than 75 years
Division of Cardiovascular and Thoracic Surgery, Good Samaritan Hospital and Medical Center, Portland, Ore.
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