|Mortasawi A et al.|
Arterial myocardial revascularization in the 9th decade of life - own results and literature review
Journal of Clinical and Basic Cardiology 1999; 2 (1): 53-60
Keywords: alter Mensch, Bypass, Morbidität, Mortalität, Überleben, coronary artery bypass grafting, morbidity, mortality, octogenarians, survival
Due to the fact that the entire population shows a progressively increasing portion of older people and due to the medical-technical progress it comes to an increase of the average age of patients undergoing heart surgery. In view of the limited life expectancy, the arterial revascularization in the 9th decade of life is faced with controversial discussions. We have analysed our patients in relation to this aspect. Between January 1st, 1995 and June 6th, 1998 103 patients in the 9th decade of life (44 women, 59 men, 80 to 88 years old, median: 82 years) underwent isolated myocardial revascularization surgery supported by a heart-lung machine. We performed 69 (67 %) elective, 24 (23 %) urgent and 10 (10 %) emergency surgeries. 14 patients (13.6 %) solely received venous bypasses (group I), 89 (86.4 %) additionally also received unilateral bypasses of the internal mammary artery (IMA) (group II). 4 patients died at our facility (3.9 %), 3 further patients died during the follow-up treatment in outlying hospitals, the hospital mortality rate in group I therefore presented a rate of 7.1 %, in group II 6.7 % and in total, a rate of 6.8 %. In 1997, the hospital mortality rate could be reduced to 2.4 % (1/42). The rate of stroke was 4.9 %, the rate of perioperative myocardial infarct was 3.9 %. There was no evidence of a dependency on IMA-application. The follow-up observation time ranged between 2 and 45 months (median: 15 months). The survival rate for patients in group I was after one year 82.5 %, after two years 71 %. The survival rate for patients in group II was after one year 89.7 %, after two years 81 %. The absence rate of angina after one year was 88 % in group I, and 93 % in group II. The differences were not significant. Whereas 94 % of the patients could preoperatively be related to class III or IV of the NYHA-classification, 89 % of the survivors belonged to class II. The myocardial revascularization with the internal mammary artery performed on patients in the 9th decade of life discloses ? in relation to solely venous coronary bypasses ? a comparably acceptable morbidity and mortality. The more prolonged follow-up observation period will clarify whether the arterial myocardial revascularization also represents itself as the superior method in this age category. J Clin Basic Cardiol 1999; 2: 53-60.