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      In-Hospital Complications of Coronary Artery Bypass Graft Surgery in Patients Older Than 70 Years

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          Abstract

          Introduction: Cardiovascular diseases contribute to mortality and morbidity in aged individuals. It is crucial to have a clear perception of coronary artery bypass graft (CABG) risks and benefits to make logical decision in aged patients. Unfortunately, cardiovascular disease researches have focused very little on the aged patients. The aim of the present study is to evaluate in-hospital complications in patients older than 70 years old following CABG operation to determine if CABG is preferred or not considering present complications.

          Methods: In a cross sectional study, 500 patients older than 70 years old were randomly selected (70-75 patients for each year) from March 2004 to March 2011. Descriptive statistical methods were used for evaluating the obtained data.

          Results: Overall, 70.6% of patients (353 individuals) were male and 29.4% were female (147 individuals). Totally, 107 patients (21.4%) had complications during hospitalization; these complications were statistically significant in male individuals. Complications included Stroke 1.6%, deep vein thrombosis 0.8%, MI 2.4%, repeat surgery 2.80%, bleeding 2.40%, and more than 48 hours mechanical ventilation in 13.4%.

          Conclusion: Need for more than 48 hours mechanical ventilation and bleeding after surgery were the most occurred complications in these patients.

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          Survival after coronary revascularization in the elderly.

          Michelle M Graham, William A Ghali, Peter Faris … (2002)
          Elderly patients with ischemic heart disease are increasingly referred for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, reports of poor outcomes in the elderly have led to questions about the benefit of these strategies. We studied survival by prescribed treatment (CABG, PCI, or medical therapy) for patients in 3 age categories: or =80 years of age. The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a clinical data collection and outcome monitoring initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, since 1995. Characteristics and long-term outcomes of a cohort of >6000 elderly patients with ischemic heart disease were compared with younger patients. In 15 392 patients >70 years of age, 4-year adjusted actuarial survival rates for CABG, PCI, and medical therapy were 95.0%, 93.8%, and 90.5%, respectively. In 5198 patients 70 to 79 years of age, survival rates were 87.3%, 83.9%, and 79.1%, respectively. In 983 patients > or = 80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients > or =80 years of age than for younger patients. Elderly patients paradoxically have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients. The combination of these results with a recent randomized trial suggests that the benefits of aggressive revascularization therapies may extend to subsets of patients in older age groups.
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            Outcomes of cardiac surgery in patients > or = 80 years: results from the National Cardiovascular Network.

            K P Alexander, K. Anstrom, L Muhlbaier … (2000)
            The purpose of this study was to evaluate characteristics and outcomes of patients age > or =80 undergoing cardiac surgery. Prior single-institution series have found high mortality rates in octogenarians after cardiac surgery. However, the major preoperative risk factors in this age group have not been identified. In addition, the additive risks in the elderly of valve replacement surgery at the time of bypass are unknown. We report in-hospital morbidity and mortality in 67,764 patients (4,743 octogenarians) undergoing cardiac surgery at 22 centers in the National Cardiovascular Network. We examine the predictors of in-hospital mortality in octogenarians compared with those predictors in younger patients. Octogenarians undergoing cardiac surgery had fewer comorbid illnesses but higher disease severity and surgical urgency than younger patients. Octogenarians had significantly higher in-hospital mortality after cardiac surgery than younger patients: coronary artery bypass grafting (CABG) only (8.1% vs. 3.0%), CABG/aortic valve (10.1% vs. 7.9%), CABG/mitral valve (19.6% vs. 12.2%). In addition, they had twice the incidence of postoperative stroke and renal failure. The preoperative clinical factors predicting CABG mortality in the very elderly were quite similar to those for younger patients with age, emergency surgery and prior CABG being the powerful predictors of outcome in both age categories. Of note, elderly patients without significant comorbidity had in-hospital mortality rates of 4.2% after CABG, 7% after CABG with aortic valve replacement (CABG/AVR), and 18.2% after CABG with mitral valve replacement (CABG/MVR). Risks for octogenarians undergoing cardiac surgery are less than previously reported, especially for CABG only or CABG/AVR. In selected octogenarians without significant comorbidity, mortality approaches that seen in younger patients.
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              Acute kidney injury: a relevant complication after cardiac surgery.

              Giovanni Mariscalco, Roberto Lorusso, Carmelo Dominici … (2011)
              Acute kidney injury (AKI) occurs in as many as 40% of patients after cardiac surgery and requires dialysis in 1% of cases. Acute kidney injury is associated with an increased risk of mortality and morbidity, predisposes patients to a longer hospitalization, requires additional treatments, and increases the hospital costs. Acute kidney injury is characterized by a progressive worsening course, being the consequence of an interplay of different pathophysiologic mechanisms, with patient-related factors and cardiopulmonary bypass as major causes. Recently, several novel biomarkers have emerged, showing reasonable sensitivity and specificity for AKI prediction and protection. The development and implementation of potentially protective therapies for AKI remains essential, especially for the relevant impact of AKI on early and late survival. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Thorac Res
                Journal ID (iso-abbrev): J Cardiovasc Thorac Res
                Journal ID (publisher-id): J Cardiovasc Thorac Res
                Journal ID (pmc): JCVTR
                Journal ID (publisher-id): TBZMED
                Title: Journal of Cardiovascular and Thoracic Research
                Publisher: Tabriz University of Medical Sciences
                ISSN (Print): 2008-5117
                ISSN (Electronic): 2008-6830
                Publication date (Print): 2015
                Volume: 7
                Issue: 2
                Pages: 60-62
                Affiliations
                1 Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
                2 Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
                3 Department of Cardiac Surgery, Behsat Hospital, School of Medical Science, Tehran, Iran
                Author notes
                [* ] Corresponding author: Naser Safaie, drsafaie@ 123456yahoo.com
                Article
                DOI: 10.15171/jcvtr.2015.13
                PMC ID: 4492179
                PubMed ID: 26191393
                SO-VID: 885fc4a8-d030-4150-aa68-552ee2c7877f
                Copyright © © 2015 The Author(s)
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 January 2015
                Date accepted : 07 June 2015
                Page count
                Figures: 2, Tables: 1, References: 17, Pages: 3
                Categories
                Subject: Original Article

                Keywords: coronary arteries bypass graft,complications,thrombosis
                Data availability:
                Keywords: coronary arteries bypass graft, complications, thrombosis

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