CORONARY ARTERY BYPASS SURGERY IN ELDERLY PATIENTS: 20 YEARS OF EXPERIENCE
P. Carmona*, E. Mateo**, A. Mena***
*Cardiac anesthesia-intensive care H. La Fe. Valencia. Spain, **Cardiac anesthesia-intensive care and ***Cardiac Surgery H. General. Valencia. Spain

Backgroung: As increasing the age of patients undergoing cardiac surgery, the identification of main postoperative complications of this population and the evaluation of institutional outcomes is essential. We aim to describe our experience in CABG in elderly patients older than 80 years old comparing intraoperative and postoperative outcomes with younger population.
Method: From January 1993 to June 2013, 3097 patients underwent consecutive emergency and scheduled CABG surgery. 1770 underwent on-pump CABG and 1327 off-pump CABG according to surgeon´s criteria. Patients undergoing on-pump receiving other concomitant procedure and re-operations were excluded. Patients older than 80 years old were identified.
Results. We identified 98 patients older than 80 years old (80-group) (mean age 82±3.5 years old) and 2957 younger than 80 years old (control group) (mean age 64.2±9.7 y.o.). Additive EuroSCORE was 8.4±4.8 and 4.6±4.6 (p<0.001) in 80-group vs control group respectively and there was a higher incidence of female sex( 28.6% vs 18.6%) and hypertension (75.4% vs 62.3%) in the 80-group. Off-pump CABG was performed in 79.6% vs 41.6% (p<0.001) in the 80-group vs control group respectively. The average of grafts performed was lower in the 80-group, 2.7 ± 0.8 vs 3.2 ± 1.0 (p<0.001). However, the anterior descent artery was revascularized in 98% vs 97.5% (p=0.6) with arterial grafts in 92.9% vs 94.3%(p=0.5) respectively in both groups. There was a significantly higher 30d-mortality in the 80-group, 11.2% vs. 3.3%, respectively (p<0.001). ICU and hospital length of stay (LOS) were not significantly different 3.6 ± 2.2 days vs 4.4±12.1 days (p=0.5) and 9.0±10.0 days vs. 6.8±10.8 d (p=0.8) respectively. Patients in the 80-group underwent reintervention for bleeding, 9.2% vs 2.9% (p=0.001) and had more frequently cardiovascular complications (atrial fibrillation and cardiogenic shock) 22.4% vs 10.9% (p=0.002) than control group. Neurological, respiratory and renal complications were more frequent in the control group 2.0% vs. 3.1% (p=0.55), 9.2 % vs. 11.7% (p=0.4), 5.1% vs. 6.1% (p=0.6).
Discussion: CABG is performed preferably in patients older than 80 years old under off-pump procedure. The mortality is higher in this group on patients based on a higher incidence of haemodynamic complications and reintervention for bleeding in the immediate postoperative period. Neurological complications were not more frequent probably due to the higher incidence of Off-CABG. Specific measures to prevent and treat those adverse events could help to improve outcomes.

Coronary artery bypass graft (CABG) surgery in elderly patients older than 80 years old: 20 years of experience