Coronary Artery Bypass Grafting in the Elderly: Analysis of a 12 Year-Experience in a Single Center

Background: Surgical treatment of coronary heart disease in the aging population is a challenge requiring thorough preoperative assessment and graft evaluation. This study investigates risk factors, adjustments to the surgical procedure and the outcome in patients older than 75 years.

Methods: 4931 isolated CABG procedures performed from 2010 to 2021 were retrospectively analyzed in our database. We compared patients 75 years and older with younger patients and correlated the preoperative characteristics, the surgical therapy and the 30-day follow-up.

Results: At the time of surgery 1252 (25.4%) patients were at least 75 years old. Female gender was significantly higher in the elderly (24.7% vs. 15.7%; p < 0.0001), as well as the rate of left main stenoses (37.2% vs. 31.2%; p = 0.0001). Prevalence of 3 vessel disease (75.9% vs. 74.0%; p = 0.15), incidence of previous PCI (21.2% vs. 23.7%; p = 0.08) and myocardial infarction (27.1% vs. 27.4%; p = 0.85) did not differ. EuroScore II was comparable as well (mean 2.9 ± 2.6 vs. 1.7 ± 2.0; p = 0.68). Central neurological disease (11.9% vs. 7.4%; p = 0.0001) and extracardiac arteriopathy (21.5% vs. 18.1%; p = 0.001) were more frequent in the elderly. Off-pump coronary artery bypass grafting (OPCAB; 58.2% vs. 38.2%; p = 0.0001) and single CABG (13.5% vs. 9.8%; p = 0.0003) were significantly more often performed in the elderly while total arterial revascularization (34.7% vs. 75.0%; p = 0.0001) and use of bilateral internal thoracic artery (21.1% vs. 63.7%; p = 0.0001) were applied less frequently. Mean operation time (236 ± 70 vs. 262 ± 79 min; p = 0.0001) was shorter in the elderly. Number of total bypasses (2.4 ± 0.8 vs. 2.5 ± 0.8; p = 0.9) was comparable in both groups. Short term outcome showed less wound infection in the elderly (2.1% vs. 3.9%; p = 0.002). Rates of postoperative myocardial infarction (1.9% vs. 1.4%; p = 0.18), stroke (2.6% vs. 2.0%; p = 0.17), mechanical circulatory support (2.7% vs. 2.5%; p = 0.76) and mean hospital stay (8.3 ± 5 vs. 8.2 ± 6 days; p = 0.10) were comparable. Renal (4.0% vs. 2.4%; p = 0.004) and multi-organ failure (1.6% vs. 0.7%; p = 0.0053) as well as 30-day-mortality (3.2% vs. 1.0%; p = 0.0001) were significantly higher in the elderly.

Conclusion: Older patients have an increased risk for postoperative renal failure and 30-day mortality, potentially due to more comorbidities. A less complex surgical approach and implementation of hybrid revascularization with more venous and single grafts as well as consequent exertion of OPCAB avoiding aortic manipulation might result in shorter operation time and relatively low postoperative cardiovascular morbidity.

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Artikel online veröffentlicht:
13. Februar 2024