Coronary arterial surgery in the elderly: its effect in the relief of angina

摘要: Financial and other constraints, such as operative risk, may prevent older patients being considered for coronary arterial bypass grafting. Grafting was performed in 315 elderly (244 males, 71 females, age 65-79, mean 69 years) between 1981-1986. All had limiting angina, 38% rest pain, 90% were housebound 80% triple-vessel disease. Impairment of left ventricular function absent 46%, mild 20%, moderate 23% severe 10% patients. Grafts (saphenous vein or internal mammary artery) inserted into 3 vessels (52%), 4 (42%), 5 (6%), 6 (0.5%). Death during surgery occurred 1.6% a further 3.5% died later the same admission (70% deaths among 33% with preoperative impairment). Surgical complications included myocardial infarction (8%), cerebrovascular accident (1%), transient cerebral vascular ischaemia (5%), chest infection (10%) wound (4%). Median stay on intensive care unit 1 day median total hospital 12 days. 299 therefore survived to leave follow-up data are available 217 (72%) these. 96% subjectively improved by surgery, 88% free angina no antianginal drugs 72 weeks (range 8-307) 8% not limited medical therapy 85 9-302) after surgery. We conclude that is an effective treatment elderly. This will have consequences future resource allocation if be denied because financial rather than clinical restraints.