Coronary artery bypass grafting in patients over 80 years of age: a single-centre experience

Background: Extended length of human life leads to an increased number of the elderly with coronary artery disease. Advanced age does not constitute a contraindication for surgical revascularisation. However, as reflected by the available risk scores, mortality risk associated with operating patients in the 9th decade of life is increased. Aim: To characterise patients over 80 years of age undergoing coronary artery bypass grafting (CABG) and to evaluate in-hospital mortality in the study group. Methods: We retrospectively analysed medical records of 51 patients over 80 years of age who underwent CABG in a cardiac surgical department of a regional cardiology centre in 2008-2011. The following factors were taken into consideration: coexisting diseases, laboratory test results, echocardiographic findings, surgical data, and in-hospital mortality. EuroSCORE (European System for Cardiac Operative Risk Evaluation) I and EuroSCORE II risk scores were used for preoperative risk assessment. Results: The mean age in the study group was 81.7 years. Coexisting diseases included hypertension in 76.5% of patients, impaired renal function in 62.7% of patients, heart failure in 31.4% of patients, atrial fibrillation (AF) in 21.6% of patients, and diabetes mellitus in 15.7% of patients. Most patients had a history of myocardial infarction (MI). CABG was performed using cardiopulmonary bypass in 51.6% of patients. The most frequent complications were new onset AF which occurred in 41.2% of operated patients and low cardiac output syndrome which was observed in 37.3% of patients. In-hospital mortality rate among patients over 80 years of age undergoing CABG was 3.9%, lower than predicted by the logistic EuroSCORE I (9.1%) and EuroSCORE II (7.3%). Two patients died during the postoperative period, including one operated with the use of cardiopulmonary bypass. Conclusions: The most common concomitant conditions in the elderly patients undergoing cardiac surgery are hypertension and impaired renal function. The majority of operated patients already suffered a MI. AF and low cardiac output syndrome are the most common postoperative complications. Among patients above 80 years of age, operative mortality risk predicted using the EuroSCORE I and EuroSCORE II may be overestimated. Patient selection for cardiac surgery must be based on individual factors, taking into account the feasibility of postoperative rehabilitation and the potential for improved survival and quality of life.