We read with great interest the article by Kelly Smith and colleagues about coronary artery bypass grafting in octogenarians and septuagenarians.1 We recently published the results of our experience with coronary artery surgery in octogenarians.2 Between January 1990 and December 2000, 3282 patients underwent surgical myocardial revascularization at Montpellier University Hospital in France. Forty-two (1.3%) of these patients were 80 years of age or older. Of this group, 13 (31%) underwent valvular replacement with bioprosthesis and 5 (11.9%) died in the first 30 postoperative days. The principal factor associated with decreased survival was valvular replacement. However, long-term results were excellent for patients who underwent isolated coronary surgery; the probability of survival was greater than 85% at 5 years.
In a preliminary retrospective study at the Montreal Heart Institute, we compared the results of coronary artery bypass grafting surgery with and without cardiopulmonary bypass (“on-pump” and “off-pump”) in patients over 80 years of age.3 We found a statistically significant difference in early mortality: about 20% of patients in the on-pump group died in the first 30 postoperative days, compared with 6% of patients in the off-pump group.
In octogenarians without serious comorbidities, age should not be a contraindication for surgical myocardial revascularization. Moreover, off-pump coronary artery bypass surgical techniques may reduce the early mortality rate for octogenarians. A prospective randomized study is warranted to confirm this hypothesis.
Roland G. Demaria Simon Fortier Michel Carrier Louis P. Perrault Cardiovascular Surgeons Department of Surgery Montreal Heart Institute Montreal, Que.
References
- 1.Smith KM, Lamy A, Arthur HM, Gafni A, Kent R. Outcomes and costs of coronary artery bypass grafting: comparison between octogenarians and septuagenarians at a tertiary care centre. CMAJ 2001; 165(6):759-64. [PMC free article] [PubMed]
- 2.Demaria R, Rouvière P, Vergnes C, Albat B, Piot C, Frapier JM, et al. Résultats de la chirurgie coronaire chez l'octogénaire. Arch Mal Cœur 2001;94:659-64. [PubMed]
- 3.Demaria RG, Fortier S, Martineau R, Cartier R, Pellerin M, Hébert Y, et al. Comparative results of coronary artery bypass grafting surgery with and without cardiopulmonary bypass in patients over 80 years of age [abstract]. Circulation 2001; 104 (2 Suppl):443.