Abstract 2281: Eighteen Year Follow-up Demonstrates Prolonged Survival and Enhanced Quality of Life for Octogenarians following Coronary Artery bypass Surgery
Background: Octogenarians comprise the fastest growing segment of our population. Numerous reports have documented an improved ability to accomplish coronary artery bypass surgery (CABG) in this high risk population. The two key questions that remain are 1) what is the quality of life (QOL) following surgery? and, 2) how sustainable is the benefit?
Methods: Serial cross-sectional analyses were performed on 1,062 consecutive patients 80 years and older who underwent isolated on-pump CABG from 1989 –2001 (98.6% complete). After a mean follow-up of 3.4 years (1 month to 12.6 years) SF-36 QOL survey was administered to all survivors. Patient records were subsequently (Nov, 2007) linked to the Social Security Adminstration’s Death Master File. Cox regression analysis was performed to determine risk factors for late mortality.
Results: Mean age at operation was 83.1 +/−2.8 years (80 –99). Overall operative mortality was 9.7%, but dropped progressively during the study period. Patients scored higher on SF-36 than age-adjusted norms in both physical and mental health summary scores, especially in the domains of Role Physical (p=0.001), Bodily Pain (p=0.001) and Role Emotional (p=0.00 –1). Similar or improved health status compared with one year previously was reported by 78.9% of patients, with 97.1% being in CCS class I or II at mid-term follow-up. Mean survival of those not alive at late follow-up was 5.6 years, while mean survival of those still alive at late follow-up was 10.2 years. Half of the patient’s survived 6 years or longer, while over one quarter survived longer than 10 years. Preoperative risk factors associated with late mortality were age (p=0.001), history of congestive heart failure (p=0.034), peripheral vascular disease (p=0.001), renal insufficiency p=0.001), cerebrovascular disease (p=0.012), arrhythmia (p=0.013) and prior myocardial infarction (p=0.035).
Conclusions: In an era of improving surgical and medical management of coronary artery disease in the elderly, select octogenarians undergoing CABG enjoy an improved QOL and enhanced survival, both of which support surgical intervention in this high risk population.