CURRENT STATUS OF CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS 70 YEARS OF AGE AND OLDER

One hundred and seventy patients 70 years of age and older underwent i solated coronary artery bypass grafting (CABG) from January 1990 to De cember 1991 at St. Vincent's Hospital, Melbourne, Australia. The clini cal records of these patients were analysed to investigate whether eld erly patients could undergo safe coronary artery surgery and to determ ine the factors affecting the outcome. The 30 day or in-hospital morta lity was 2.9% (5/170), with 80% (4/5) of the deaths due to cardiac cau ses. Major postoperative complications occurred in 22.3% (38/170) pati ents. The median postoperative hospital stay for the patients was 8 da ys (range 3-103 days). Univariate analysis identified hypertension and female gender as pre-operative risk factors and intraaortic balloon p ump, prolonged ventilation, infarct, tamponade, need for inotropes, re nal failure and a high APACHE II scores in the intensive care unit as postoperative significant risk factors for operative mortality. There was a trend towards increased mortality with emergency operations; the operative mortality was 2.1% (2/97) for elective operations, 3.1% (2/ 64) in urgent cases and 11.1% (1/9) for emergencies. Multivariate logi stic regression analysis identified prolonged mechanical ventilation, peri operative infarct and APACHE II score as significant independent predictors of mortality. The low operative mortality indicates that el derly patients can undergo safe revascularization. A high incidence of complications necessitates careful monitoring but age per se should n ot be considered a contraindication to isolated CABG.