Coronary artery bypass grafting in octogenarians

We thank Roland Demaria and colleagues for their interest in our article on coronary artery bypass graft (CABG) surgery in octogenarians and septuagenarians.¹ It is encouraging that similar results in octogenarians are being reported in other provinces and surgical institutions. Our results suggest that CABG surgery in octogenarians (without concomitant valve replacement) is as safe as, and no more costly than, CABG in the younger septuagenarian group, when octogenarians are appropriately triaged. As suggested by Ghali and Graham,² an open discussion and debate on the ethical and societal implications of adopting a policy of aggressive revascularization treatment in elderly patients needs be undertaken. First, however, further investigation on the nonmedical outcomes of CABG surgery, such as health-related quality of life, self-efficacy and the impact on independent living, needs to be conducted to bring to this debate a full awareness of the risks and benefits of CABG surgery in elderly patients.

Demaria and colleagues also bring up an interesting point with respect to CABG surgery without the use of cardiopulmonary bypass (“off-pump”). This particular topic was recently discussed in Oct. 2001 at the first meeting of the Canadian Registry for Off-Pump CABG Surgery. This was a Canadian Institutes of Health Research University/Industry funded project, bringing together surgeons from across Canada to develop a data set from which future research will emerge. Results from our first year of data collection will be presented at the Canadian Cardiovascular Congress in October.

Kelly M. Smith Project Coordinator McMaster University CADENCE Research Group Hamilton Health Sciences Hamilton, Ont. André Lamy Assistant Professor, Clinical Epidemiology and Biostatistics McMaster University Hamilton, Ont. Heather M. Arthur Associate Professor Faculty of Health Sciences McMaster University Hamilton, Ont. Amiram Gafni Professor Faculty of Health Sciences McMaster University Hamilton, Ont. Rosanne Kent Research Coordinator McMaster University Hamilton, Ont.