Graft selection in elderly patients undergoing coronary artery bypass grafting

Fukui, Toshihiro; Tabata, Minoru; Matsuyama, Shigefumi; Takanashi, Shuichiro

doi:10.1007/s11748-011-0836-7

Cited by 5 publications

(6 citation statements)

References 19 publications

(24 reference statements)

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“…The internal thoracic artery is considered to be the most reliable revascularization graft for diseased coronary arteries because of its long-term durability [15]. The left internal thoracic artery is usually used for revascularization of the left anterior descending coronary artery, even in elderly patients [16]. In the present study, 64% of patients in each group had lesions in the left anterior descending artery.…”

Section: Discussionmentioning

confidence: 51%

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Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Fukui

Bando

Tanaka

et al. 2013

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: Although the number of elderly patients undergoing combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) is increasing, the early and mid-term outcomes of this combined procedure remain to be determined. We sought to elucidate the early and mid-term outcomes of elderly (≥75 years) vs non-elderly (<75 years) patients who underwent combined AVR and CABG. METHODS:Between September 2004 and September 2011, 259 patients underwent combined AVR and CABG at our institute, including 155 elderly patients (59.8%; Elderly group) with a mean age of 79.8 ± 3.6 years and 104 non-elderly patients (40.2%; Non-elderly group) with a mean age of 67.3 ± 5.8 years. Early and mid-term outcomes were compared, and multivariate analyses were performed to determine the risk factors for morbidity and mortality. The mean follow-up times were 33.1 ± 21.7 and 37.4 ± 22.2 months in the Elderly and Non-elderly groups, respectively. RESULTS:The mean number of anastomoses and the frequency of use of the internal thoracic artery were similar between the two groups. The use of a mechanical valve was less frequent in the Elderly group than in the Non-elderly group (11.6 vs 60.6%, P < 0.001). The Elderly and Non-elderly groups had similar rates of operative death (1.9 vs 1.0%, P = 0.651), early stroke (2.6 vs 1.0%, P = 0.651), 5-year overall survival (83.1 ± 4.8 vs 87.2 ± 5.2%, P = 0.358), 5-year freedom from cardiac death (92.3 ± 2.7 vs 94.8 ± 3.4%, P = 0.570) and 5-year freedom from stroke (94.0 ± 2.6 vs 99.0 ± 1.0%, P = 0.097). Cox proportional hazards analyses identified diabetes, creatinine level and EuroSCORE II, but not age, as independent predictors of overall mortality rate.CONCLUSIONS: Early and mid-term outcomes of combined AVR and CABG were similar between elderly and non-elderly patients. Older age was not a risk factor for mortality in patients undergoing combined AVR plus CABG, and this procedure should be recommended in properly selected elderly patients.

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Section: Discussionmentioning

confidence: 51%

“…Moreover, we believe that improvements in surgical techniques, critical care medicine and rehabilitation care may contribute to achieving equivalent outcomes in both elderly and non-elderly patients. The use of internal thoracic artery grafts may also contribute to improved long-term outcomes in both elderly and non-elderly patients [16].…”

Section: Adult Cardiacmentioning

confidence: 99%

Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Fukui

Bando

Tanaka

et al. 2013

European Journal of Cardio-Thoracic Surgery

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“…Although use of the internal thoracic artery favors long-term survival in these patients [19], one of many issues which remains unresolved is the importance of complete revascularization. Comparably excellent graft patency can be achieved between elderly and nonelderly patients [51]. Kozower et al [52] found diminished survival in octogenarians with incomplete revascularization, whereas Mohammadi et al [53] more recently reported just the opposite.…”

Section: Long-term Survivalmentioning

confidence: 99%

Do octogenarians benefit from coronary artery bypass surgery

Kurlansky

2012

Current Opinion in Cardiology

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Although it is clear that CABG surgery in octogenarians can be accomplished with increasingly good results, future research will need to focus on what specific surgical strategies are most appropriate for this elderly cohort; how the collaborative 'Heart Team' approach can be most effectively applied to determination of the most appropriate therapeutic course for these complex, frequently high-risk patients; what strategies can be applied to best manage and possibly reverse patient frailty; and what economic models most meaningfully inform clinical and public policy decision-making.

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“…Не приходится удивляться сопоставимыми значени-ями прогноза у больных через год после КШ, поскольку недавно было показано, что проходимость шунтов через год после операции составляла 91,6% среди больных до 75 лет и 89,3% среди пациентов 75 лет и старше (р=0,28) [8]. Более важными прогностиче-скими факторами оказались распространенность коронарного и некоронарного атеросклероза, выра- женность дислипидемии, наличие систолической дис-функции левого желудочка, что вполне ожидаемо.…”

Section: Discussionunclassified

One-year results of coronary artery stenting in elderly patients

Сумин¹,

Гайфулин²,

Ivanov³

et al. 2013

Russ J Cardiol

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Aim.To study the one-year survival after coronary artery stenting (CAS) across age groups and to identify the predictors of cardiovascular events registered during the follow-up period. Material and methods. In total, 662 patients who underwent CAS were divided into 4 groups: Group I -under 60 years (n=363); Group II -60-64 years (n=140); Group III -65-69 years (n=88); Group IV -70+ years (n=71). The end-points, registered during the one-year follow-period, included death, myocardial infarction (MI), stroke (S), repeat revascularisation, and their combinations. In addition, the pre-and peri-intervention predictors of the abovementioned cardiovascular events were analysed. Results. Based on the one-year follow-up data, there was an insignificant increase in all-cause mortality among older patients. However, the difference in cardiovascular mortality across the groups was statistically significant (p for trend 0,04). In multivariate regression analyses, age was not independently associated with the risk of cardiovascular death, while atherogenic index, decreased left ventricular contractility, and post-intervention renal dysfunction were independent predictors of cardiovascular mortality. The independent predictors of combined end-point were circulatory support duration, peri-intervention S, and the lesions in two or more coronary arteries. Conclusion. In one year after CAS, 65-69-year-old patients demonstrated higher cardiovascular mortality levels, with no apparent increase in all-cause mortality and the incidence of combined end-point. Age was not an independent predictor of the one-year risk of cardiovascular events.

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Graft selection in elderly patients undergoing coronary artery bypass grafting

Abstract: The clinical and angiographic outcomes after CABG in elderly patients were almost identical to those in nonelderly patients.

Cited by 5 publications

References 19 publications

Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients

Do octogenarians benefit from coronary artery bypass surgery

One-year results of coronary artery stenting in elderly patients

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