Risk factors and outcomes after coronary reoperation in 739 elderly patients

Background. As second coronary artery bypass graft (CABG) operations are be coming more common in elderly patients, we conducted a retrospective analys is of risk factors for in-hospital and late outcome in patients aged 70 and over. Methods. We reviewed records of 739 patients who underwent second CABG at a ge 70 or older at our institution between 1983 and 1993. Preoperative, oper ative, and postoperative variables were analyzed to identify predictors of in-hospital and long-term mortality. Results. The mean age (+/- standard deviation) at reoperation was 74 +/- 3 years and the mean interval after primary operation was 130 +/- 55 months. In-hospital mortality was 7.6% (n = 56). Preoperative factors associated wi th increased in-hospital mortality were preoperative creatinine greater tha n 1.6 mg/dL (p < 0.001), emergency operation (p < 0.001), female sex (p = 0 .012), moderate or severe left ventricular dysfunction (p = 0.049), and lef t main coronary disease (p = 0.045). In-hospital, actuarial survival was 75 % at 5 years and 49% at 10 years. Cardiac event-free survival was 60% at 5 years and 27% at 10 years. The factors independently associated with increa sed late death were hematocrit (p = 0.046), diabetes (p = 0.011), periphera l vascular disease (p < 0.001),left ventricular function (p < 0.001), histo ry of cancer (p = 0.016), preoperative nonsinus rhythm (p 0.003), anticoagu lation or antiplatelet therapy (p = 0.018), postoperative encephalopathy (p = 0.001), and postoperative stroke (p = 0.014). Conclusions. CABG reoperation can have excellent results for many elderly p atients, but mortality is markedly higher when elderly patients have certai n risk factors and comorbidities, alone or in combination. This information should be helpful in educating patients before they decide whether to choo se reoperation. (C) 2000 by The Society of Thoracic Surgeons.