Abstract
To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients > 65 years-old. Patients undergoing isolated on-pump CABG from December 1st 2010 to July 31th 2012 were divided in two groups: GE (elderly > 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation--MV--and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization. In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age > 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors. This study suggests that patients > 65-year old were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.
Highlights
The growth of the elderly population, in absolute and relative numbers, is a worldwide phenomenon and is occurring at an unprecedented level
The clinical and demographic characteristics of the patients are summarized in Table 1, which demonstrates a higher prevalence of males in both groups: group of elderly (GE) = 61% and GA = 70%; no difference regarding gender, history of coronary artery disease (CAD) in the family, hypertension, alcohol consumption, sedentary lifestyle, acute myocardial infarction (AMI), coronary angiography (CAT), previous angina pectoris, previous peripheral vascular disease (PVD), previous coronary artery bypass surgery (CABG), chronic renal failure (CRF) and failure chronic heart failure (CHF) and dyslipidemia
Patients in the GA had a higher prevalence of diabetes mellitus (DM) (39.6% vs. 27%, P=0.043) and smoking (32.2% vs. 19.8%, P=0.042), whereas the GE patients had a higher prevalence of stroke prior (17% vs. 6.7%, P=0.013)
Summary
The growth of the elderly population, in absolute and relative numbers, is a worldwide phenomenon and is occurring at an unprecedented level. One in ten people aged 60 or older. In year 2050, it is estimated that the ratio will be one to five in the world, and one to three in developed countries. In Brazil, life expectancy has increased more than ten years (62.57 years to 73.17 years) and it is estimated that in 2050, the Brazilian population over 15% of people have 70 years or older [1]. Advanced age is a risk factor for development of coronary artery disease (CAD), diabetes mellitus, hypertension, dyslipidemia, smoking, obesity and family history of CAD. Population has greater prevalence of CAD, and more inclinable to major coronary procedures as coronary artery bypass surgery (CABG). Cardiovascular disease is the major factor contributing to death, especially in elderly [2,3,4]
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