Jt. Christenson et al., THE INFLUENCE OF AGE ON THE RESULTS OF REOPERATIVE CORONARY-ARTERY BYPASS-GRAFTING, Coronary artery disease, 8(2), 1997, pp. 91-96
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.