FORUM MŁODYCH Isolated coronary artery bypass grafting in extracorporeal circulation in patients over 65 years old – does age still matter?

Abstract

IntroductionCoronary artery bypass grafting (CABG) is conducted more and more commonly in patients in advanced age.Aim of the studyTo analyze the influence of age and concurrent risk factors on the complications and early mortality after CABG.Material and methodsMedical records of 2194 patients were analyzed retrospectively. A group of 1303 patients who had undergone isolated CABG was selected. 106 (4.8%) patients were excluded due to missing data in their medical records. The remaining 1197 patients were divided into two subgroups by age: 1st group < 65 years (n = 662; 55.3%); 2nd group ≥ 65 years (n = 535; 44.7%).ResultsThe total 30-day mortality was 3.93% and was six times higher in the older group (1.21 vs. 7.29%; p < 0.001). Complications were observed in 176 (14.70%) patients, more often in the older group (10.42% vs. 20.0%; p < 0.001). In this group all kinds of complications were noted more often and in particular: postoperative myocardial infarction (1.96% vs. 5.42%; p = 0.001), respiratory dysfunction (1.36% vs. 4.11%; p = 0.005), neurological complications (1.81% vs. 3.74%; p = 0.04) and multi-organ dysfunction syndrome (0.30% vs. 1.68%, p = 0.03). The older patients required longer time under mechanical ventilation (24.0 ± 27.9 vs. 37.0 ± 74.1 hours; p = 0.004) and stayed longer in the intensive care unit: 2.5 ± 3.0 vs. 4.1 ± 7.84 days; p < 0.001. Independent predictors of death were: female sex [OR (95% CI) = 2.4 (1.2-4.5)], age ≥ 65 years [OR = 4.9 (2.1-11.1)], eGFR < 60 mL/min/1.73 m2 [OR = 2.2 (1.0-4.7)], time at extracorporeal circulation > 72 minutes [OR = 5.5 (2.7-10.9)] and left main stem stenosis (> 50%) [OR = 2.4 (1.3-4.6)].ConclusionsAge still significantly influences postoperative complications and mortality after isolated CABG.

Czynniki ryzyka zwiększonego drenażu klatki piersiowej u pacjentów poddawanych operacji pomostowania aortalno-wieńcowego bez użycia krążenia pozaustrojowego

“…Such a result is in agreement with previous results [1,14]. Moreover, some authors showed that lower BSA is also a risk factor of higher drainage [4]. We have found that patients, whom BSA was noted in the first deciles, had higher drainage than those found in the last ones.…”

“…This affects final clinical outcome of treatment as patients undergoing re-exploration due to postoperative bleeding have higher mortality and longer hospitalization [1,4,5]. To achieve reliable results we eliminated two risk factors.…”

“…We eliminated impact of surgeon's experience on results of treatment [7] by including into the study patients operated only by a single, experienced cardiac surgeon. Moreover, we excluded patients operated on-pump, which it is another important risk factor for postoperative bleeding [2,4,8].…”

“…Such treatment strategy can be found in 2-12% of patients operated in cardiac surgery departments [1,2]. However, this complication increases the risk of in-hospital mortality from 2.72 to 22% of reoperated patients [3,4]. Decision for reoperation should be considered if mediastinal blood drainage excides 200 mL/h in the first 4 postoperative hours or when reported bleeding is rapid [2].…”

Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting?

“…25 This fragility contributes to several intra-and postoperational risks. 26 In turn, this leads to more physicians favoring less invasive treatments due to concerns that complex procedures would lead to poorer outcomes when combined with these patients' frailty.…”