Surgery in relatively healthy patients between the age of 70 to 80 in the absence of diabetes, left ventricular dysfunction, and other cardiovascular atherothrombotic disease undergo bypass surgery with a small added risk compared to younger patients. In a large series of patients intraoperative mortality was 3.8% in men versus 6.2% in women. The presence of the above conditions and other comorbid conditions increases the risk considerably to more than 7%.
A. Octogenarian Study
Study question: Is there a difference in outcomes among octogenarians undergoing bypass surgery using cardio-pulmonary bypass or surgery without cardiopulmonary bypass.
Methods: Bypass surgery was performed in patients 80 years or older using cardiopulmonary bypass in 63 and 62 surgeries were without cardiopulmonary bypass. Base¬line left ventricular EF and comorbidity were similar in the groups preoperatively and the mean number of grafts in patients did not differ.
Results: The operative mortality was higher in the cardiopulmonary bypass group, 15.9 versus 4.8% in those without bypass (P ¼ 0.04). More patients in the cardio-pulmonary bypass group required blood transfusion, 92% versus 73% ( p ¼ 0.01). Postoperative myocardial infarc¬tion was similar, 11% versus 15%. This remarkable study should prompt a large randomized trial to confirm the results.