How They Fare: Octogenarians Undergoing Coronary Artery Bypass Grafts

Abstract

Objective: Cardiac surgery is being performed on older and sicker patients with excellent outcomes. Percutaneous coronary intervention may be used in preference for high-risk patients with IHD, who would otherwise benefit from CABG. This renewed our interest in the outcomes for octogenarians undergoing surgical revascularisation. Methods: A retrospective analysis was performed, of 96 patients aged 80-89 years, undergoing CABG, from 2010-2016, at three Western Australian hospitals. Outcomes measured were 30-day mortality, stroke and duration of ICU and hospital stay, new renal failure and arrhythmia. Results: The mean age was 82.4 years with a 73% male preponderance. There was pre-existing congestive cardiac failure (CCF) in 9.3%, 11.4% had a prior cerebrovascular accident (CVA) and 18.7% had chronic obstructive pulmonary disease (COPD). Forty-six per cent underwent CABG alone and an equal number had concomitant aortic valve replacement (AVR). An IABP was placed for 3 people preoperatively, and another one to facilitate wean from bypass. The mean ICU stay was 3 days and the mean total hospital stay was 13.8 days. Further rehabilitation was needed post acute episode of care, for 31 patients. One patient had a CVA and 36.2% developed a new arrhythmia. There were 3 sternal wound infections requiring further intervention and 4 leg wound infections. The 30-day mortality was 3.1%. No patient required nursing home placement. Two patients required further PCI at mean follow-up of 24 months. Conclusion: The provision of CABG for octogenarians can be achieved with success and an acceptable risk profile, with increased requirement for allied health's rehabilitation services.