Isolated coronary artery bypass grafting in one hundred consecutive octogenarian patients. A multivariate analysis.
Academic Article
Overview
abstract
One hundred consecutive patients aged 80 or older underwent isolated coronary artery bypass grafting for New York Heart Association functional class III (24%) or IV (76%) disease in our institution from 1985 to 1989. The operations were elective in 36 patients, urgent in 52, and emergent in 12. Twenty-eight patients had significant disease of the left main coronary artery, with the remainder having an average of 2.8 diseased coronary vessels. Preoperative left ventricular ejection fraction was considered good (greater than 50%) in 62 patients, fair (30% to 50%) in 24 patients, and poor (less than 30%) in 14 patients. An average of 2.8 grafts were performed per patient, and the internal mammary artery was used in 10 patients. Univariate analysis of 36 perioperative factors followed by multivariate logistic regression analysis of the significant variables (p less than 0.05) revealed that the urgency of the operation and left ventricular ejection fraction were independent predictors of operative mortality. There were 12 in-hospital deaths, and the mortality was significantly lower in the elective cases (2.8%) than in the urgent (13.5%) and emergent cases (33.3%). Major complications occurred in 14% of the elective cases, in 21% of the urgent cases, and in 67% of the emergent cases. The operative mortality rates for good, fair, and poor left ventricular ejection fraction were 4.9%, 12.5%, and 42.9%, respectively. Long-term follow-up averaging 22 months revealed a 77% actuarial probability of survival at 24 months and 51% at 48 months, with only two cardiac-related deaths. We conclude that coronary artery bypass grafting can be performed in octogenarians with a favorable outcome when done electively in patients with normal to moderately depressed left ventricular function.
