Coronary artery bypass grafting in the elderly

Background ann methods: The incidence of coronary artery bypass grafting (CABG) in elderly patients has been increasing. We retrospectively analyzed the results of CABG performed at Shin-Tokyo Hospital between January 1, 1991, and December 31, 1998, Preoperative, perioperative, and follow-up data of patients greater than or equal to 75 years old (group E, n = 190) were collected, and compared with those of patients < 75 years old (group Y, n = 1,380), Results: Female gender, emergent CABG, preoperative balloon pumping use, cardiogenic shock, hypertension, and preoperative cerebral vascular accident were significantly more frequent in group E (p < 0,05). CABG was completed without any significant differences, except for less frequent use of the bilateral internal mammary artery (p < 0,01), more frequent use of the saphenous vein (p < 0,005), and a greater incidence of blood transfusion in group E (p < 0,0001), The postoperative course required longer intubation, ICU stay, and postoperative hospital stay in group E (p < 0,001), and was more frequently associated with major complication (p < 0.0001) and in-hospital death (p < 0,05), During the mean follow-up of 2.7 years (maximum 6,9 years), the actuarial 5-year survival of groups E and Y were 84.3% and 92.5% (p < 0.01), respectively, excluding in-hospital mortality. The actuarial 5-year cardiac event-free rates were 79.9% in group E and 79.7% in group Y, showing no significant difference. Conclusions: CABG in the elderly carries certain surgical risks. However, the long-term cardiac event-free rate after CABG in the elderly was almost the same as that of younger patients. Inferior long-term survival in the elderly was most likely due to the biological nature of aging.