Determinants of operative mortality in octogenarians undergoing coronary bypass.

BACKGROUND

The elderly segment of the population is increasing rapidly, and surgeons are being asked to consider patients more than 80 years old as candidates for coronary bypass. The objective of this study was to identify risk factors that may adversely affect mortality as well as analyze functional outcomes and survival in octogenarians undergoing coronary bypass.

METHODS

From July 1989 through February 1994, 300 consecutive patients 80 years of age and older underwent coronary artery bypass grafting. There were 176 men (58.7%) and 124 women (41.3%) with a mean age of 80.9 years (range, 80 to 99 years). Preoperatively, 274 patients (91.3%) had disabling angina, 76 (25.3%) had left main coronary stenosis greater than 50%, and 293 patients (98.3%) were in New York Heart Association class III or IV.

RESULTS

The overall hospital mortality was 11.0% (33/300) with an elective mortality of 9.6% (23/240), urgent mortality of 11% (5/45), and emergent mortality of 33.3% (5/15). Significant independent predictors of operative mortality were preoperative renal dysfunction, postoperative pulmonary insufficiency, postoperative renal dysfunction, use of intraaortic balloon pumping, and sternal wound infection. The actuarial survival for patients discharged from the hospital was 74.6% +/- 5.6% (standard error of the mean) at 54 months.

CONCLUSIONS

A favorable outcome may be expected when coronary artery bypass grafting is performed in patients 80 years of age or older with severe angina.