[Surgical myocardial revascularization in patients over and under 70 years of age: results and prognostic factors]. / Rivascolarizzazione miocardica chirurgica nei pazienti di età superiore ed inferiore a 70 anni: risultati e fattori prognostici.

ABSTRACT

BACKGROUND: The increase in mean age has made older patients candidates to myocardial revascularization. This study is focused to evaluate hospital mortality and major postoperative complications in two groups of patients < or = 70 or > 70 years. The possible confounder effect of other important risk factors has been studied in multivariate models. METHODS: From January 1 to December 31, 2002, 228 patients < or = 70 years (group A) and 116 patients > 70 years (group B) underwent isolated myocardial revascularization. We analyzed the incidence of hospital mortality, cardiac failure, postoperative bleeding, major arrhythmias, atrial fibrillation, respiratory failure, renal failure, sternal infection, stroke, transient ischemic attack, total neurological complications, and number of patients with at least one of these complications. Univariate statistical analysis was used to compare this two groups and multivariate analysis to adjust for four known important risk factors, i.e. sex, diabetes, ejection fraction < 0.40, and off-pump surgical technique. RESULTS: Hospital mortality was statistically higher in group B than in group A (7.8 vs 1.7%, p < 0.05). The incidence of cardiac failure, although higher in group B, was not statistically significant. Multivariate analysis confirmed low ejection fraction as the only statistical risk factor for low cardiac output (p < 0.05). Atrial fibrillation was statistically higher in group B (p < 0.05). No difference was found for all other complications considered. Age, low ejection fraction and the use of cardiocirculatory bypass at multivariate analysis were statistically significant risk factors for the incidence of at least one postoperative event. CONCLUSIONS: Myocardial revascularization in patients > 70 years has a higher mortality and morbidity. At multivariate analysis, low ejection fraction is also confirmed as a significant risk factor for low cardiac output and total morbidity. At the same time, the technical option of "beating heart" myocardial revascularization seems to achieve better results and probably it should be used more extensively in this group of patients.