HOW SAFE IS CORONARY-BYPASS SURGERY IN THE ELDERLY PATIENT - ANALYSISOF 111 PATIENTS AGED 75-YEARS OR MORE AND 2939 PATIENTS YOUNGER THAN 75-YEARS UNDERGOING CORONARY-ARTERY BYPASS-GRAFTING IN A PRIVATE HOSPITAL

Aim and methods: Data from patients younger than 75 years (group I, n = 2939) and patients aged 75 years or older (group II, n = 111) who un derwent isolated coronary artery bypass grafting (CABG) during a 9-yea r period (January 1984 to April 1993) were analyzed to determine compa rative risk factors for morbidity, early and late survival, and functi onal outcome. Results: Traditional risk factors (hypertension, hyperli pidemia, diabetes mellitus, and smoking) were significantly more preva lent in group II. The number of patients in New York Heart Association (NYHA) functional classes 3 and 4 before surgery was also significant ly higher in group II (P<0.001), but emergency operations were equally distributed between the groups. Left main-stem stenosis was more freq uent in group II patients (P<0.01), while the number of vessels involv ed and pre-operative left ventricular function did not differ. Both gr oups underwent a mean of 4.5 grafts. Internal mammary grafts were plac ed in 48.4% (1422/2939) in group I and 19.8% (22/111) in group II (P<0 .001). The overall peri-operative mortality rate did not differ betwee n the groups (2.9% for group I and 2.7% for group II). Non-fatal peri- operative myocardial infarction, ventricular arrhythmias, postextracor poreal circulation disorientation, and temporary renal insufficiency w ere more prevalent in group II patients (all P<0.05). Emergency operat ions and re-operative CABG increased the peri-operative mortality in b oth groups. The 3-year survival rate was 93% and the 3-year cardiac ev ent-free rate was 88% for the group II patients. Most of the elderly p atients (98%) were in NYHA functional classes 1 and 2 at the end of th e follow-up. Conclusions: Even if elderly patients have a slightly hig her postoperative morbidity than younger patients, and an increased mo rtality if operated upon in an emergency, long-term survival and freed om from cardiac events are excellent and justify the continued perform ance of CABG in patients aged 75 years of age or more.