Coronary artery bypass graft surgery in the elderly

ABSTRACT

A total of 5,070 patients 65 years of age or older underwent primary elective coronary bypass surgery at The Cleveland Clinic Foundation from January 1976 through June 1986. These patients were divided by age into two groups, 65-74 years of age and 75 years and older; these groups were compared with each other and with patients younger than 65 years. With advancing age, there was a significantly greater prevalence of women, more severe angina, diabetes, peripheral vascular disease, previous cerebral events, cardiac enlargement, and left main coronary artery disease. Overall mortality during hospitalization was 2.3% and rose progressively with advancing age. Variables predictive of higher operative mortality included age >75 years, cigarette smoking, left ventricular impairment, and female gender. Perioperative myocardial infarction and wound complications showed no correlation with age, but other morbidity occurred more frequently in older patients. Stroke was more common over age 65, and postoperative atrial fibrillation rose significantly with advancing age. After a mean follow-up of 91 months, angina relief was better in the elderly than among their younger counterparts (P = 0.0001), and vein and arterial graft patency were comparable. The 10-year actuarial survival was 64% for ages 65-74 and the eight-year survival for patients 75 or older was 53%. Successful bypass surgery among the elderly conferred consistent angina relief and longevity that exceeds that of the U.S. population, matched for age and gender.