Abstract
Background: Coronary artery bypass grafting (CABG) is associated with higher operative risk in
the elderly compared to younger patients. The aim of this study was to evaluate risk
factors for perioperative mortality after CABG in the elderly. Methods: We investigated 325 consecutive patients aged 75 or over undergoing isolated CABG
at our institution. We analyzed the patients' characteristics and perioperative outcome.
Patients were divided into survivors and non-survivors; risk factors and complications
were compared. Based on this, we performed a multivariate logistic regression analysis
to determine independent risk factors for perioperative mortality. Results: Non-survivors of CABG more often suffered from concomitant extracar- diac atherosclerosis
(non-survivors, 62.2 %; survivors, 40.6 %; p = 0.013) as well as from renal insufficiency
preoperatively (non-survivors, 35.1 %; survivors 8.0 %; p < 0.0001). A trend towards
higher incidences of impaired left ventricular function (non-survivors, 37.8 %; survivors,
29.9 %; p = 0.105) and a history of recent myocardial infarction (non-survivors, 29.7
%; survivors, 17.0 %; p = 0.061) were found in non-survivors compared to survivors.
Furthermore, non-survivors more often underwent CABG with cardiopulmonary bypass (CPB
non-survivors, 96.1 %; survivors 70.6 %; p = 0.0005). Multivariate logistic regression
analysis revealed that preoperatively impaired renal function (OR: 2.857, p < 0.0001),
use of CPB (OR: 5.952, p = 0.0175), extracardiac atherosclerosis (OR: 1.581, p = 0.0228),
and recent myocardial infarction (OR: 1.574, p = 0.0405) were independent risk factors
for perioperative mortality. Comparison of patients undergoing CABG with or without
CPB reveals that patients operated without CPB had a higher preoperative risk than
patients undergoing CABG with CPB. Conclusion: These results show that besides impaired renal function, extracardiac atherosclerosis,
and history of recent myocardial infarction, the use of CPB is a major risk factor
for CABG in the elderly. Perioperative mortality and morbidity can be significantly
reduced if CPB is avoided.
Key words
Coronary artery bypass grafting - cardiopulmonary bypass - elderly - risk
References
- 1
Craver J M, Puskas J D, Weintraub W W. et al .
601 octogenarians undergoing cardiac surgery: outcome and comparison with younger
age groups.
Ann Thorac Surg.
1999;
67
1104-1110
- 2
Estefanous F G, Loop F D, Higgins T L. et al .
Increased risk and decreased morbidity of coronary artery bypass grafting between
1986 and 1994.
Ann Thorac Surg.
1998;
65
383-389
- 3
Bergsland J, Hasnan S, Lewin N, Bhayuany J, Lajos T Z, Salerno T A.
Coronary artery bypass grafting without cardiopulmonary bypass - An attractive alternative
in high risk patients.
Eur J Cardio-thorac Surg.
1997;
11
876-880
- 4
Boyd W D, Desai N D, Del Rizzo D F, Novick R J, McKenzie F N, Menkis A H.
Off-pump surgery decreases postoperative complications and resource utilization in
the elderly.
Ann Thorac Surg.
1999;
68
1490-1493
- 5
Nashef S AM, Roques F, Michel P. et al .
European system for cardiac operative risk evaluation (EuroSCORE).
Eur J Cardio-thorac Surg.
1999;
16
9-13
- 6
Parsonnet V, Dean D, Bernstein A D.
A method of uniform stratification of risk for evaluating the results of surgery in
acquired adult heart disease.
Circulation.
1989;
79
I-3-I-12
- 7
Kannel W, Larson M.
Long-term epidemiologic prediction of coronary artery disease. The Framingham experience.
Cardiology.
1993;
82
137-152
- 8
Wan S, Izzat M B, Lee T W, Wan I YP, Tang N LS, Yim A PC.
Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and
myocardial injury.
Ann Thorac Surg.
1999;
68
52-57
- 9
Koutlas T C, Elbeery J R, Williams J M. et al .
Myocardial revascularization using beating heart coronary artery bypass surgery.
Ann Thorac Surg.
2000;
69
1042-1047
- 10
Liu J Y, Birkmeyr N J, Sanders J H. et al .
Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass
surgery.
Circulation.
2000;
102
2973-2977
- 11
Khaitan L, Sutter F P, Goldman S M.
Coronary artery bypass grafting in patients who require long-term dialysis.
Ann Thorac Surg.
2000;
69
1135-1139
- 12
Anderson R J, O'Brien M, McWhinney S. et al .
Renal failure predisposes patients to adverse outcome after coronary artery bypass
surgery.
Kidney Int.
1999;
55
057-1062
- 13
Szcech L A, Reddan D N, Owen W F. et al .
Differential survival after coronary revascularization procedures among patients with
renal insufficiency.
Kidney Int.
2001;
60
292-299
- 14
Conlon P J, Stafford-Smith M, White W D. et al .
Acute renal failure following cardiac surgery.
Nephrol Dial Transplant.
1999;
14
1158-1162
- 15
Riess F C, Moshar S, Bader R. et al .
Clinical Outcome of patients with and without renal impairment undergoing a minimally
invasive LIMA-to-LAD bypass operation.
Heart Surg Forum.
2000;
3
313-318
- 16
Gamoso M G, Phillips-Bute B, Landolfo K P. et al .
Off-pump versus on-pump coronary artery bypass surgery and postoperative renal dysfunction.
Anesth Analg.
2000;
91
1080-1084
- 17
Kennedy J W, Kaiser G C, Fisher L D. et al .
Multivariate discriminant analysis of the clinical and angiographic predictors of
operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS).
J Thorac Cardiovasc Surg.
1980;
80
876-887
- 18
Yusuf S, Zucker D, Peduzzi P. et al .
Effect of coronary artery bypass surgery on survival: overview of 10-year results
from randomized trials by the Coronary Artery Surgery Trialists Collaboration.
Lancet.
1994;
344
563-570
- 19
Samady H, Elefteriades J A, Abbott B G. et al .
Failure to improve left ventricular function after coronary revascularization for
ischemic cardiomyopathy is not associated with worse outcome.
Circulation.
1999;
100
1298-1304
- 20
Ivanov J, Weisel R D, David T E, Naylor C D.
Fifteen-year trends in risk severity and operative mortality in elderly patients undergoing
coronary artery bypass graft surgery.
Circulation.
1998;
97
673-680
MD Juliane Kilo
Department of Cardiothoracic Surgery, Vienna General Hospital, University of Vienna
Waehringer Guertel 18-20
1090 Vienna
Austria
Telefon: +43 (1) 404 00-56 20
Fax: +43 (1) 40 400-56 40
eMail: juliane.kilo@akh-wien.ac.at