Early results of surgical coronary revascularization in patients 65 years and older
Walczak, A.; Jaszewski, R.; Jegier, B.; Iwaszkiewicz, A.; Ostrowski, Sław.; Zwoliński, Rław.; Zasłonka, J.
Przeglad Lekarski 59(4-5): 239-240
2002
ISSN/ISBN: 0033-2240 PMID: 12183975 Document Number: 546903
276 patients aged 65 years or more, who underwent coronary artery bypass grafting in the Department of Cardiac Surgery, Medical University of Łódź in 1999 and 2000, were assessed. The analyzed group consisted of 193 men (69.93%) and 83 women (30.07%). The mean age of the patients was 69.14 years (+/- 3.42, age range from 65 to 79 years), 18 (6.52%) patients were in the first functional class of CCS classification, 55 pts (19.93%) in the second, 106 pts (38.41%) in the third and 97 pts (35.14%) in the fourth class. 87 patients (31.52%) had no history of myocardial infarction, 137 pts (49.28%) had a history of 1 infarction and 53 pts (19.2%) of 2 or more myocardial infarctions. 68.12% of patients smoked cigarettes. Arterial hypertension was observed in 176 pts (63.77%), diabetes mellitus in 50 pts (18.11%), chronic renal failure in 10 pts (3.62%), a history of stroke in 8 pts (2.9%), peptic ulcer in 42 pts (15.22%). Left ventricular ejection fraction below 30% was observed in 16 (5.8%) patients. 10 pts (3.62%) underwent coronary angioplasty and in 26 pts (9.42%) critical stenosis of the left main stem was observed. All patients were operated on cardiopulmonary bypass and myocardial protection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 224 patients (81.16%) were operated electively. In early postoperative period the following complications were observed: death--35 (12.68%), low cardiac output syndrome--84 (30.43%), need of use of intraaortic contrapulsation--31 (11.23%), perioperative myocardial infarction--44 (15.94%). Respiratory complications were observed in 83 pts (30.07%), neurological complications in 7 pts (2.54%), acute renal failure in 25 pts (9.06%), intestinal bleeding in 5 pts (1.81%). Rethoracotomy was necessary in 12 of the operated (4.35%). Currently the age of a patient is considered as one of many risk factors and should not be treated as a contraindication to surgical revascularization procedure. In the analyzed material mortality correlated with a number of risk factors. It is to remember that the elderly have higher prevalence of coexisting diseases and that is why their exposure to the perioperative complications is also higher.