Demographic changes in coronary artery bypass surgery and its effect on mortality and morbidity

Abstract

Over the past 4-5 years, possibly with the advent of percutaneous transluminal coronary angioplasty (PTCA), there has been a changing patient population for coronary artery bypass surgery (CABS) with a gradual increase in the operative mortality. In an attempt to analyze the changing demographics in patients undergoing CABS and its effect on operative mortality, we analyzed data from 5536 consecutive patients undergoing isolated CABS. There was 4151 patients less than 70 years of age and 1385 patients greater than 70 years. Reoperative CABS procedures were performed in 385 patients, and CABS for post infarction unstable angina pectoris was performed in 578 patients. During the same time period, 2910 patients underwent PTCA. The mean age of bypass patients was 68.5 years with 38% being 70 years or older. The left ventricular ejection fraction in patients undergoing CABS averaged 38%. The average number of bypasses performed was 3.1. In comparison, patients presenting for PTCA were younger (average age 55), had normal ejection fractions (average 55%) and were predominantly treated for single or double vessel disease. The hospital mortality for elective CABS in patients less than 70 years of age was 1.8%, for reoperative CABS 3.6%, for post infarction unstable angina pectoris 4%, and for patients greater than 70 years 8%, for a combined operative mortality of 4.8%. These data suggest that because of the increasing number of elderly patients (greater than 70 years of age), and the increasing number of reoperative CABS cases and acute myocardial infarction patients with unstable angina pectoris presenting for CABS, the operative mortality will continue to rise.

Surgical Revascularization in Elderly Patients with and Without Cardiopulmonary Bypass

“…Older patients show an increased incidence of comorbidity, such as: diabetes, hypertension, COPD and kidney disease. Previous results of CABG in the treatment of patients in this age group are burdened with a high rate of morbidity and mortality (9), which has prompted cardiac surgeons to investigate the applicability of alternative and less invasive methods such as surgery without the use of CPB (10).…”

A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery

“…In questa popolazione i soggetti anziani sono particolarmente rappresentati per vari motivi: prolungamento della vita media, maggiori attese di vita, percentuale sempre più elevata di soggetti sottoposti ad intervento di chirurgia cardiaca, minore grado d'indipendenza rispetto ai soggetti più giovani e conseguente maggiore richiesta d'ospedalizzazione. 5,6 In RC uno dei quesiti che viene posto al cardiologo è quello di valutare il grado d'efficienza fisica del soggetto da riabilitare al fine di ottimizzare l'intervento terapeutico.…”

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery

“…The evolution in surgical techniques and changing demographics and patient selection for CABG surgery have led to its application in older and sicker patients with more complex disease (441). Nearly all reports during the past 10 years define "elderly" in the context of coronary surgery as age 70 years or older.…”