Coronary Artery Bypass Graft Surgery in the Elderly / 대한흉부외과학회지

ABSTRACT

BACKGROUND:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. MATERIAL AND METHOD: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. RESULT: Mean age was 68+/-1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 +/-0.81 and mean aortic cross-cramp time was 69.84+/-18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23+/-10.62% preoperatively to 58.14+/-9.88% postoperatively(p.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27+/-12.51 vs 15.55+/-6.99 days; p<0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean 23.58+/-19.56 months). There was no late mortality of cardiac origin. CONCLUSION: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.