Comparison of Surgical CABG Procedures and Short-term Follow-up of Patients Younger or Older than 80 Years of Age: A Single-Center Analysis

Objectives: Cardiac surgeons are confronted with an increasing number of elderly patients referred for surgery. The aim of this analysis was to evaluate if patients older than 79 years are being treated differently to the younger collective. Especially the use of the right internal thoracic artery (RITA), the number of OPCAB procedures and the short-term clinical outcome are of paramount interest.

Methods: We reviewed all 4,219 isolated CABG procedures performed in our hospital during the years 2010–2016. We compared patient characteristics, the surgical therapy and the 30-day follow-up retrospectively in our EQS-database.

Results: At the time of the operation 340 (8.1%) patients were at least 80 (82.4 ± 2.0) years old (≥ 80) versus 3879 (91.9%) patients under 80 (65.9 ± 9.1) years (< 80). Percentage of women was 34% versus 18% (≥ 80 versus < 80, p < 0.001). Old patients had significantly higher NYHA-Class (NYHA>2: 58.9% versus 45.1%, p < 0.001) and higher prevalence of vascular disease (27.1% versus 19.4%, p < 0.001) while the prevalence of diabetes mellitus (21.8% versus 29.3%, p = 0.019) was lower. The rates of a known neurological disease (5.0% versus 6.4%, p = 0.374), left main stenosis (44.4% versus 39.0%, p = 0.12), and previous myocardial infarctions (35.3% versus 36.9%, ≥ 80 versus < 80, p = 0.142) were similar. Older patients had less pervious PCI (19.7% versus 23.9%, p = 0.079). Older patients underwent significantly more OPCAB procedures (65.3% versus 38.8%, p < 0.005). As expected, the mean number of distal (2.35 ± 0.9 versus 2.59 ± 1.0, ≥ 80 versus < 80, p < 0.001) and arterial anastomoses (1.1 ± 0.5 versus 1.84 ± 0.9, ≥ 80 versus < 80, p < 0.001) was significantly lower in aged patients. We found significant differences in the use of venous grafts (75.6% versus 45.2%, ≥80 versus < 80, p < 0.001), RITA (7.6% versus 54.2%, p < 0.001) and mean operation time was (183 minute versus 219 minute, p < 0.001). Postoperative myocardial infarction (1.8% versus 1.3%, ≥80 versus < 80, p = 0.46), rate of rethoracotomy (5.9% versus 5.4%, p = 0.61) and stroke (1.8% versus 1.2%, p = 0.59) were comparable. Postoperative hospital stay (8.8 ± 5.8 versus 7.9 ± 5.4 days, p = 0.002), as well as hospital (3.8% versus 1.5%, p < 0.001) and 30-day-mortality (5.0% versus 2.2%, p < 0.001) differed significantly.

Conclusion: Aged patients had tolerable postoperative complication rate and early mortality in our patient group. The surgical handling was significantly less complex by using venous and single grafts. OPCAB surgery may have a protective influence in elderly patients.