THE INFLUENCE OF AGE ON THE RESULTS OF REOPERATIVE CORONARY-ARTERY BYPASS-GRAFTING

Background With a steady increase in the number of elderly patients re quiring coronary artery bypass grafting (CABG), a larger portion of el derly patients will also become candidates for reoperative CABG, Scept icism still exists as to whether this operation is justified in older patients. The purpose of this study was to examine the effect of incre asing age on the outcome after reoperative CABG. Methods Between Janua ry 1, 1990 and June 30, 1996 563 patients underwent isolated reoperati ve CABG, and were included in this retrospective analysis. Patients wh o had combined procedures were excluded. The patients were divided by age into two groups: those aged 69 years or less (n = 507), and those older than 70 years (n = 56), Hospital mortality and morbidity for eac h group was compared. Medium-term survival for each group was compared with that of their age-matched population derived from Swiss life tab les. Results The patients aged 70 years and older had a higher New Yor k Health Association functional class, and more patients had unstable angina requiring urgent surgery than did the younger patients, The eld erly also showed an over-representation of diabetes and multifocal vas cular disease (generalized arteriosclerotic disease), and there was a higher number of patients with triple-vessel disease and left stenosis (greater than or equal to 70%) in this group. Patients aged 70 years and older received fewer distal anastomoses (3.0 versus 3.6; P < 0.01) , and had a longer cardiopulmonary bypass time compared with the young er patients, but the ischemia time was similar in both groups. Hospita l mortality was higher in patients older than 70 years (7.1 versus 17. 9%), There was an increased frequency of postoperative low cardiac out put and a higher incidence of gastrointestinal complications and trans ient renal failure amongst the elderly patients (greater than or equal to 70 years). Despite a higher hospital mortality rate and slightly i ncreased morbidity the 5-year survival was excellent, and comparable w ith the age-matched population in both groups [89.6% (< 70 years) and 76.2% (greater than or equal to 70 years)], The cardiac event-free sur vival was 79.8% (< 70 years), and 69.9% (greater than or equal to 70 y ears) after 5 years. Conclusion An acceptable early mortality and long -term survival together with good functional long-term results support the justification of reoperative CABG in older patients, at least up to the age of 80 years.