DETERMINANTS OF OPERATIVE MORTALITY IN OCTOGENARIANS UNDERGOING CORONARY-BYPASS

Background. The elderly segment of the population is increasing rapidl y, and surgeons are being asked to consider patients more than 80 year s old as candidates for coronary bypass. The objective of this study w as to identify risk factors that may adversely affect mortality as wel l as analyze functional outcomes and survival in octogenarians undergo ing coronary bypass. Methods. From July 1989 through February 1994, 30 0 consecutive patients 80 years of age and older underwent coronary ar tery bypass grafting. There were 176 men (58.7%) and 124 women (41.3%) with a mean age of 80.9 years (range, 80 to 99 years). Preoperatively , 274 patients (91.3%) had disabling angina, 76 (25.3%) had left main coronary stenosis greater than 50%, and 293 patients (98.3%) were in N ew York Heart Association class III or IV. Results. The overall hospit al mortality was 11.0% (33/300) with an elective mortality of 9.6% (23 /240), urgent mortality of 11% (5/45), and emergent mortality of 33.3% (5/15). Significant independent predictors of operative mortality wer e preoperative renal dysfunction, postoperative pulmonary insufficienc y, postoperative renal dysfunction, use of intraaortic balloon pumping , and sternal wound infection. The actuarial survival for patients dis charged from the hospital was 74.6% +/- 5.6% (standard error of the me an) at 54 months. Conclusions. A favorable outcome may be expected whe n coronary artery bypass grafting is performed in patients 80 years of age or older with severe angina.