Coronary bypass surgery in the elderly

The incidence and severity of coronary artery disease increase with age. Because the mortality and morbidity of patients over the age of 70 are higher than those for younger patients, many earlier studies comparing the effectiveness of bypass surgery to medical management deliberately excluded patients over the age of 65. Presently, however, there are many reports on the morbidity and mortality of patients having coronary bypass sugery who are over the age of 65 and 70 and even in some reports, over the age of 80. Compared with younger patients, the elderly have more severe disease, frequent comorbidity, and a slightly higher perioperative mortality and morbidity. In properly selected patients, that is patients in whom the major problem is the coronary artery disease and not multisystem failure, the benefit from coronary artery bypass surgery as far as relief of angina and improvement of physical activity is concerned is equal to the benefit that younger patients experience. Unlike younger patients, in patients over 75 years of age, the goal of surgery is not necessarily to prolong life, although in the appropriate patients this probably occurs, but to decrease or eliminate angina and return the patient to more normal activity and a better quality of life.