Coronary artery bypass surgery in old age group: is age itself a barrier?

OBJECTIVE To analyse the data retrospectively and identify risk factors that may adversely affect mortality in patients aged seventy years and older with coronary artery bypass graft (CABG). METHODS From Jan 2003 to Oct 2007, 63 consecutive patients of 70 years or older underwent primary isolated CABG on cardiopulmonary bypass (CPB) in Department of Surgery, Liaquat National Hospital. Forty one (65%) were male. The mean age was 72.7 +/- 3 years (range 70 to 81 years). Preoperatively 83% were in New York Heart Association (NYHA) class III or IV. Left main stem (LMS) lesion (> 70%) was present in 20 (32%). Renal impairment (RI) with creatinine more then 2 mg/dl was present in 9 (14%) patients. History of prior stroke was present in 7 (11%). Emergency surgery (within 48 hours after Myocardial Infarct (MI)) was performed in 33 (52%) patients. RESULTS The overall hospital mortality (30 days) was 9.5%. The mean Parsonet score was 23 +/- 3, and 10 +/- 3 in those who died or survived respectively. Mean intensive care unit stay was 2.3 +/- 0.7 days, mean ward stay was 6 +/- 3 days. Preoperative LMS lesion or MI less then 48 hours, poor left ventriculal function, prolonged CPB time and post operative stroke were the significant independent predictors of operative morality. CONCLUSION CABG can be performed in a selected elderly population. Careful attention to risk factors associated with high mortality can be helpful in improving post-operative morality. Age in itself may not be responsible for high morality.