Surgical Therapy of Coronary Heart Disease in the Elderly: Analysis of 10 Years CABG in a Single Center

Objectives: Surgical treatment of coronary heart disease in elderly people is a challenge and difficult, despite a precise risk–benefit assessment. The analysis is intended to show the differences in the preoperative risk factors and the resulting adjustments to the surgical procedure in patients older than 79 years and younger patients.

Methods: In a retrospective analysis all 5,640 isolated CABG procedures performed in our hospital during the years 2010 to 2019 were evaluated. We compared patient characteristics, the surgical therapy and the 30-day follow-up retrospectively in our EQS database.

Result: At the time of the operation, 433 (7.7%) patients were at least 80 years and older (82.2 ± 2.0, ≥ 80 vs. 65.8 ± 9.2 years <80). Percentage of women was 31.4% versus 18% (≥80 vs. <80, p < 0.001). Old patients had a higher prevalence of 3 vessel disease (78.8% vs. 74.4%, p = 0.005) and left main stenosis (46.7 vs. 38.3%, ≥ 80 vs. <80, p = 0.002). Aged patients had less pervious PCI (19.6 vs. 24.2%, ≥ 80 vs. <80, p = 0.032) and comparably often myocardial infarction (6.3 vs. 7.5%, ≥ 80 vs. <80, p = 0.449).), lower portion of diabetes mellitus (20.5 vs. 25.2%, ≥ 80 vs. <80, p = 0.048) and a higher percentage of vascular diseases (25.2 vs. 19.2%, ≥ 80 vs. <80, p = 0.001)

We found significant differences in the use of OPCAB (65.5 vs. 38.1%), total arterial revascularization (23.6 vs. 57.4%), bilateral internal thoracic artery (8.3 vs. 56.2%), and portion of single bypass (15.9 vs. 12.3%, ≥ 80 vs. <80, p < 0.001). Number of distal anastomosis (2.35 ± 0.86 vs. 2.55 ± 0.93, ≥ 80 vs. <80, p = 0.02) and mean operation time (192 ± 65 vs. 226 ± 69 minute, ≥ 80 vs. <80, p = 0.175) were comparable.

Postoperative hospital stay (9.1 ± 5.9 vs. 8.1 ± 5.5 days), hospital mortality (4.2 vs. 1.3%), and 30-day mortality (5.1 vs. 1.9%) were significantly different between both subgroups (≥80 vs. <80, p < 0.001).

Conclusion: Aged patients have an acceptable but clearly increased perioperative risk in operative revascularization. The surgical handling was significantly less complex by using venous and single grafts. The protective influence of OPCAB surgery is not certain and individual risk assessment seems to be essential for the patients.

Publication History

Article published online:
19 February 2021