Objective To make sure of the values that old patients go for CABG operation; and to understand operative risks, main complications and techniques through studying patient aged 75 and above who underwent CABG. Metho...Objective To make sure of the values that old patients go for CABG operation; and to understand operative risks, main complications and techniques through studying patient aged 75 and above who underwent CABG. Methods A retrospective review of 62 patients aged 75 and above who underwent CABG between January 1992 and December 1996 was done in January 1997 with the usage of conduits, operative time, techniques, mortality and complications listed. The differences between old patients and general group were studied by statistics method. Results The median age was 76 (range from 75 to 85) with equal sex distribution. 54(87%) had triple vessel disease; 8(13%) had double vessel disease; 14(22%) had significant left main disease. 57(92%) were elective cases; 5(8%) were emergency cases. The average number of grafts was 3.1. The internal mammary artery was used in 18(29%) patients. The gastroepiploic artery was used in 1(1.5%) patient. The immediate post operative complications encountered were: 2(3%) re openings for low CO, 1(1.5%) reopening for bleeding, 2(3%) First Teaching Hospital of Beijing Medical University, Beijing 100034, China (Tao L, Chen HY) Singapore General Hospital, Singapore (Tan TE, Tan YS, Chua YL and S Shankar) perioperative infarctions, 2(3%) mediastinitis, 2(3%) CVAs, 2(3%) bleeding GIT, 6(10%) leg wound infections and 10(16%) arrhythmias(mostly AF). There were 3(4.5%) operative deaths. 1 was for an elective CABG, 2 were emergency. The remaining 2(3%) patients were redone CABGs. The mean period of follow up was 2 years. 3(4.8%) patients had recurrence of angina, currently on medical treatment. 7(11%) patients died during the follow up period. Of these, 5(8%) had non cardiac related causes of death. The remaining 2(3%) died of heart failure. Discussion Most of patients had left main and triple vessel disease and had unstable angina with poor EF. A bypass operation can provide very good symptomatic relief of angina for elderly patients. The long term survival rate and freedom from angina were excellent. The low rate of mortality and major complications and the substantial improvement in quality of life lead us to conclude that, when indicated, surgical treatment should be offered to selected elderly individuals who are in good physical and mental health. Mortality of elective cases were 2%, emergency were 40%. So the indication for emergency cases must be very strict. Conclusion Coronary artery bypass can be done with acceptable mortality and morbidity in a carefully selected group of elderly patients.展开更多
文摘Objective To make sure of the values that old patients go for CABG operation; and to understand operative risks, main complications and techniques through studying patient aged 75 and above who underwent CABG. Methods A retrospective review of 62 patients aged 75 and above who underwent CABG between January 1992 and December 1996 was done in January 1997 with the usage of conduits, operative time, techniques, mortality and complications listed. The differences between old patients and general group were studied by statistics method. Results The median age was 76 (range from 75 to 85) with equal sex distribution. 54(87%) had triple vessel disease; 8(13%) had double vessel disease; 14(22%) had significant left main disease. 57(92%) were elective cases; 5(8%) were emergency cases. The average number of grafts was 3.1. The internal mammary artery was used in 18(29%) patients. The gastroepiploic artery was used in 1(1.5%) patient. The immediate post operative complications encountered were: 2(3%) re openings for low CO, 1(1.5%) reopening for bleeding, 2(3%) First Teaching Hospital of Beijing Medical University, Beijing 100034, China (Tao L, Chen HY) Singapore General Hospital, Singapore (Tan TE, Tan YS, Chua YL and S Shankar) perioperative infarctions, 2(3%) mediastinitis, 2(3%) CVAs, 2(3%) bleeding GIT, 6(10%) leg wound infections and 10(16%) arrhythmias(mostly AF). There were 3(4.5%) operative deaths. 1 was for an elective CABG, 2 were emergency. The remaining 2(3%) patients were redone CABGs. The mean period of follow up was 2 years. 3(4.8%) patients had recurrence of angina, currently on medical treatment. 7(11%) patients died during the follow up period. Of these, 5(8%) had non cardiac related causes of death. The remaining 2(3%) died of heart failure. Discussion Most of patients had left main and triple vessel disease and had unstable angina with poor EF. A bypass operation can provide very good symptomatic relief of angina for elderly patients. The long term survival rate and freedom from angina were excellent. The low rate of mortality and major complications and the substantial improvement in quality of life lead us to conclude that, when indicated, surgical treatment should be offered to selected elderly individuals who are in good physical and mental health. Mortality of elective cases were 2%, emergency were 40%. So the indication for emergency cases must be very strict. Conclusion Coronary artery bypass can be done with acceptable mortality and morbidity in a carefully selected group of elderly patients.
