Skip to main content
SpringerLink
Log in

Surgery for Ischemic Coronary Disease in the Elderly

  • Chapter
  • First Online:
Cardiothoracic Surgery in the Elderly

  • 1137 Accesses

Abstract

As the elderly population grows each year, so does the number of these patients referred for cardiac intervention. The morbidity and mortality associated with these procedures have substantially decreased since the 1980s, but judicious patient selection and optimization can lower perioperative risks even further. The older the patient, the more likely the presence of multiple chronic noncardiac diseases, increased tissue fragility, and limited organ reserves for stressful events. Systematic assessment of cognitive and other functions, when possible, will help predict the operative risk and guide for the optimization of the preoperative elderly patient. During the process of deciding whether to offer cardiac surgical intervention to elderly patients, the relief of symptoms and improved quality of life should assume more importance than the issue of increased life expectancy. Comorbidities and concerns raised by the patient and family should be acknowledged and factored into the decision-making process. The overall goal is to select the least morbid and most effective procedure that is currently available.

Sections of this chapter are reprinted with permission from Camacho and Raval [1]

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Camacho MT, Raval PR. Cardiac surgery in the elderly. In: Rosenthal RE, Katlic MR, Zenilman ME, editors. Principles and practice of geriatric surgery. 2nd ed. New York: Springer; 2010.

    Google Scholar 

  2. US Census Bureau. Table 1: Annual estimates of the resident population by sex and five-year age groups for the United States: April 1, 2000 to July 1, 2008 (NC-EST2008-01). Source: Population Division, Release Date May 14, 2009 and Table 4: Annual Estimates of the Resident Population for the United States April 1, 2000 to July 1, 2008 (NST-EST 2008-01). Source: Population Division, US Census BUREAU. Release date 22 Dec 2008.

    Google Scholar 

  3. Lubitz J, Kiming C, Kramarow E, et al. Health, life expectancy and health cared spending among the elderly. N Engl J Med. 2003;349:1048–55.

    Article  PubMed  CAS  Google Scholar 

  4. Horvath KA, DiSesa VJ, Peigh PS, et al. Favorable results of coronary artery bypass grafting in patients older than 75 years. J Thorac Cardiovasc Surg. 1990;99:92–6.

    PubMed  CAS  Google Scholar 

  5. Maganti M, Rao V, Brister S, et al. Decreasing mortality for coronary artery bypass surgery in octogenarians. Can J Cardiol. 2009;25(2):e32–5.

    Article  PubMed  Google Scholar 

  6. Canver C, Nichols R, Cooler S, et al. Influence of increasing age on long-term survival after coronary artery bypass grafting. Ann Thorac Surg. 1996;62:1123–7.

    Article  PubMed  CAS  Google Scholar 

  7. Srinivasan A, Oo A, Grayson A, et al. Mid-term survival after cardiac surgery in elderly patients: analysis of predictors for increased mortality. Interact Cardiovasc Thorac Surg. 2004;3:289–93.

    Article  PubMed  Google Scholar 

  8. Alexander KP, Peterson ED. Coronary artery bypass grafting in the elderly. Am Heart J. 1997;134:856–64.

    Article  PubMed  CAS  Google Scholar 

  9. Kern LS. The elderly heart surgery patient. Crit Care Nurs Clin North Am. 1991;3:749–56.

    PubMed  CAS  Google Scholar 

  10. Mezey MD, Rauckhorst LH, Stokes SA. Health assessment of the older individual. 2nd ed. New York: Springer; 1993.

    Google Scholar 

  11. Smith Rossi M. The octogenarian cardiac surgery patient. J Cardiovasc Nurs. 1995;9(4):75–95.

    Google Scholar 

  12. Sweet J, Finnin E, Wolfe P, et al. Absence of cognitive decline one year after coronary bypass surgery: comparison to non-surgical and healthy controls. Ann Thorac Surg. 2008;85:1571–8.

    Article  PubMed  Google Scholar 

  13. Cane ME, Chen C, Bailey BM, et al. CABG in octogenarians: early and late events and actuarial survival in comparison with a matched population. Ann Thorac Surg. 1995;60:1033–7.

    Article  PubMed  CAS  Google Scholar 

  14. Williams DB, Carrillo RG, Traad EA, et al. Determinants of operative mortality in octogenarians undergoing coronary bypass. Ann Thorac Surg. 1995;60:1038–43.

    Article  PubMed  CAS  Google Scholar 

  15. Akins CW, Daggett WM, Vlahakes GJ, et al. Cardiac operations in patients 80 years old and older. Ann Thorac Surg. 1997;64:606–15.

    Article  PubMed  CAS  Google Scholar 

  16. Iskandrian AS, Segal BL. Should cardiac surgery be performed in octogenarians? J Am Coll Cardiol. 1991;18:36–7.

    Article  PubMed  CAS  Google Scholar 

  17. Shirani J, Yousefi J, Roberts WC. Major cardiac findings at necropsy in 366 American octogenarians. Am J Cardiol. 1995;75:151–6.

    Article  PubMed  CAS  Google Scholar 

  18. Iskandrian AS, Hakki AH. The effects of aging after coronary artery bypass grafting on the regulation of cardiac output during upright exercise. Int J Cardiol. 1985;7:347–60.

    Article  PubMed  CAS  Google Scholar 

  19. Hakki AH, DePace NL, Iskandrian AS. Effect of age on left ventricular function during exercise in patients with coronary artery disease. J Am Coll Cardiol. 1983;2:645–51.

    Article  PubMed  CAS  Google Scholar 

  20. Iskandrian AS, Hakki AH. Age-related changes in left ventricular diastolic performance. Am Heart J. 1986;112:75–8.

    Article  PubMed  CAS  Google Scholar 

  21. Roberts WC. Ninety three hearts ≥90 years of age. Am J Cardiol. 1993;71:599–602.

    Article  PubMed  CAS  Google Scholar 

  22. Waller BF, Roberts WC. Cardiovascular disease in the very elderly: analysis of 40 necropsy patients aged 90 years or older. Am J Cardiol. 1983;51:403–21.

    Article  PubMed  CAS  Google Scholar 

  23. Roberts WC. The aging heart. Mayo Clin Proc. 1988;63:205–6.

    Article  PubMed  CAS  Google Scholar 

  24. Gersh BJ, Kronmal RA, Schaff HV, et al. Long-term (5 year) results of coronary bypass surgery in patients 65 years or older: a report from the coronary artery surgery study. Circulation. 1983;66(Suppl II):190–9.

    Google Scholar 

  25. Naunheim KS, Kern MJ, McBride LR, et al. Coronary artery bypass surgery in patients aged 80 years or older. Am J Cardiol. 1987;59:804–7.

    Article  PubMed  CAS  Google Scholar 

  26. Morris RJ, Strong MD, Grunewald KE, et al. Internal thoracic artery for coronary artery grafting in octogenarians. Ann Thorac Surg. 1996;62:16–22.

    Article  PubMed  CAS  Google Scholar 

  27. Glower DD, Christopher TD, Milano CA, et al. Performance status and outcome after coronary artery bypass grafting in persons aged 80 to 93 years. Am J Cardiol. 1992;70:567–71.

    Article  PubMed  CAS  Google Scholar 

  28. Tsai T, Chaux A, Matloff JM, et al. Ten-year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg. 1994;58:445–51.

    Article  PubMed  CAS  Google Scholar 

  29. Ko W, Krieger KH, Lazenby WD, et al. Isolated coronary artery bypass grafting in one hundred consecutive octogenarian patients. J Thorac Cardiovasc Surg. 1991;102:532–8.

    PubMed  CAS  Google Scholar 

  30. Diegeler A, Autschbach R, Falk V, et al. Open heart surgery in the octogenarians: a study on long-term survival and quality of life. Thorac Cardiovasc Surg. 1995;43:265–70.

    Article  PubMed  CAS  Google Scholar 

  31. McGrath LB, Adkins MS, Chen C, et al. Actuarial survival and other events following valve surgery in octogenarians: comparison with age-, sex-, and race-matched population. Eur J Cardiothorac Surg. 1991;5:319–25.

    Article  PubMed  CAS  Google Scholar 

  32. Freeman WK, Schaff HV, O’Brien PC, et al. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol. 1991;18:29–35.

    Article  PubMed  CAS  Google Scholar 

  33. Bashour TT, Hanna ES, Myler RK, et al. Cardiac surgery in patients over the age of 80 years. Clin Cardiol. 1990;13:267–70.

    Article  PubMed  CAS  Google Scholar 

  34. Naunheim KS, Dean PA, Fiore AC, et al. Cardiac surgery in the octogenarian. Eur J Cardiothorac Surg. 1990;4:130–5.

    Article  PubMed  CAS  Google Scholar 

  35. Deiwick M, Tandler R, Mollhoff TH, et al. Heart surgery in patients aged eight years and above: determinants of morbidity and mortality. Thorac Cardiovasc Surg. 1997;45:119–26.

    Article  PubMed  CAS  Google Scholar 

  36. Wareing TH, Davila-Roman VG, Barzilai B, et al. Management of the severely atherosclerotic ascending aorta during cardiac operations: a strategy for detection and treatment. J Thorac Cardiovasc Surg. 1992;103:453–62.

    PubMed  CAS  Google Scholar 

  37. Cannon LA, Marshall JM. Cardiac disease in the elderly population. Clin Geriatr Med. 1993;9:499–525.

    PubMed  CAS  Google Scholar 

  38. Davis EA, Gardner TJ, Gillinov AM, et al. Valvular disease in the elderly: influence on surgical results. Ann Thorac Surg. 1993;55:333–8.

    Article  PubMed  CAS  Google Scholar 

  39. Gehlot A, Mullany CJ, Ilstrup D, et al. Aortic valve replacement in patients aged eighty years and older: early and long-term results. J Thorac Cardiovasc Surg. 1996;111:1026–36.

    Article  PubMed  CAS  Google Scholar 

  40. Sahar G, Raanani E, Sagie A, et al. Surgical results in cardiac patients over the age of 80 years. Isr J Med Sci. 1996;32:1322–5.

    PubMed  CAS  Google Scholar 

  41. Logeais Y, Roussin R, Langanay T, et al. Aortic valve replacement for aortic stenosis in 200 consecutive octogenarians. J Heart Valve Dis. 1995;4 Suppl 1:S64–71.

    PubMed  Google Scholar 

  42. Klima U, Wimmer-Greinecker G, Mair R, et al. The octogenarians: a new challenge in cardiac surgery? Thorac Cardiovasc Surg. 1994;42:212–7.

    Article  PubMed  CAS  Google Scholar 

  43. Yashar JJ, Yashar AG, Torres D, Hittner K. Favorable results of coronary artery bypass and/or valve replacement in octogenarians. Cardiovasc Surg. 1993;1:68–71.

    PubMed  CAS  Google Scholar 

  44. Tsai T, Nessim S, Kass RM, et al. Morbidity and mortality after coronary artery bypass in octogenarians. Ann Thorac Surg. 1991;51:983–6.

    Article  PubMed  CAS  Google Scholar 

  45. Mullany CJ, Darling GE, Pluth JR, et al. Early and late results after isolated coronary artery bypass surgery in 159 patients aged 80 years and older. Circulation. 1990;82(Suppl IV):229–36.

    Google Scholar 

  46. Kowalchuk GJ, Siu SC, McAuliffe LS, et al. Coronary artery bypass in octogenarians: early and late results. J Am Coll Cardiol. 1990;15:35A.

    Article  Google Scholar 

  47. Fiore AC, Naunheim KS, Barner HB, et al. Valve replacement in the octogenarian. Ann Thorac Surg. 1989;48:104–8.

    Article  PubMed  CAS  Google Scholar 

  48. Rich MW, Sandza JG, Kleiger RE, et al. Cardiac operations in patients over 80 years of age. J Thorac Cardiovasc Surg. 1985;90:56–60.

    PubMed  CAS  Google Scholar 

  49. Tsai TP, Matloff JM, Gray RJ, et al. Cardiac surgery in the octogenarian. J Thorac Cardiovasc Surg. 1986;91:924–8.

    PubMed  CAS  Google Scholar 

  50. Peterson ED, Cowper PA, Jollis JG, et al. Outcomes of coronary artery bypass graft surgery in 24,461 patients aged 80 years or older. Circulation. 1995;92(Suppl II):85–91.

    Article  Google Scholar 

  51. Curtis JJ, Walls JT, Boley TM, et al. Coronary revascularization in the elderly: determinants of operative mortality. Ann Thorac Surg. 1994;58:1069–72.

    Article  PubMed  CAS  Google Scholar 

  52. Tuman KJ, McCarthy RJ, Najafi H, et al. Differential effects of advanced age on neurologic and cardiac risks of coronary artery operations. J Thorac Cardiovasc Surg. 1992;104:1510–7.

    PubMed  CAS  Google Scholar 

  53. Lee EM, Porter JN, Shapiro LM, et al. Mitral valve surgery in the elderly. Heart Valve Dis. 1997;6:22–31.

    CAS  Google Scholar 

  54. Culliford AT, Galloway AC, Colvin SB, et al. Aortic valve replacement for aortic stenosis in persons aged 80 years and over. Am J Cardiol. 1991;67:1256–60.

    Article  PubMed  CAS  Google Scholar 

  55. Kumar P, Zehr KJ, Cameron DE, et al. Quality of life in octogenarians after open heart surgery. Chest. 1995;108:919–26.

    Article  PubMed  CAS  Google Scholar 

  56. Remington M, Tyrer PJ, Newson-Smith J, et al. Comparative reliability of categorical and analogue rating scales in the assessment of psychiatric symptomatology. Psychol Med. 1979;9:765–70.

    Article  PubMed  CAS  Google Scholar 

  57. Campbell A, Converse PE, Ridgers WL. The quality of American life. Russell Sage: New York; 1976. p. 1–583.

    Google Scholar 

  58. Bradburn NM. The structure of psychological well-being. Chicago: Aldine; 1969. p. 214–5.

    Google Scholar 

  59. Adkins M, Amalfitano D, Harnum NA, et al. Efficacy of combined coronary revascularization and valve procedures in octogenarians. Chest. 1995;108:927–31.

    Article  PubMed  CAS  Google Scholar 

  60. Merrill WH, Steward JR, Frist WH, et al. Cardiac surgery in patients age 80 years or older. Ann Surg. 1990;211:772–6.

    Article  PubMed  CAS  Google Scholar 

  61. Edmunds LH, Stephenson LW, Edie RN, et al. Open-heart surgery in octogenarians. N Engl J Med. 1988;319:131–6.

    Article  PubMed  Google Scholar 

  62. Berens ES, Kouchoukos NT, Murphy SF, et al. Preoperative carotid artery screening in elderly patients undergoing cardiac surgery. J Vasc Surg. 1992;15:313–23.

    Article  PubMed  CAS  Google Scholar 

  63. Grawlee GP, Cordell AR, Graham JE, et al. Coronary revascularization in patients with bilateral internal carotid occlusion. J Thorac Cardiovasc Surg. 1985;90:921–5.

    Google Scholar 

  64. Brener BJ, Bried DK, Alpert J, et al. The risk of stroke in patients with asymptomatic carotid stenosis undergoing cardiac surgery: a follow-up study. J Vasc Surg. 1987;5:269–79.

    PubMed  CAS  Google Scholar 

  65. Sisto DA, Hoffman DM, Fernandes S, Frater RWM. Is use of the intraaortic balloon pump in octogenarians justified? Ann Thorac Surg. 1992;54:507–11.

    Article  PubMed  CAS  Google Scholar 

  66. He GW, Acuff TE, Ryan WH, et al. Determinants of operative mortality in elderly patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1994;108:73–81.

    PubMed  CAS  Google Scholar 

  67. Ennabli K, Pelletier LC. Morbidity and mortality of coronary artery surgery after the age of 70 years. Ann Thorac Surg. 1986;42:197–200.

    Article  PubMed  CAS  Google Scholar 

  68. Higgins TL, Estafanous FG, Loop FD, et al. Stratification of morbidity and mortality outcome by pre-operative risk factors in coronary artery bypass patients: a clinical severity score. JAMA. 1992;267:2344–8.

    Article  PubMed  CAS  Google Scholar 

  69. Utley JR, Leyland SA. Coronary artery bypass grafting in the octogenarian. J Thorac Cardiovasc Surg. 1991;101:866–70.

    PubMed  CAS  Google Scholar 

  70. Weintraub WS. Coronary operations in octogenarians: can we select the patients? Ann Thorac Surg. 1995;60:875–6.

    Article  PubMed  CAS  Google Scholar 

  71. Braunstein EM, Bajwa TK, Andrei L, et al. Early and late outcome of revascularization for unstable angina in octogenarians. J Am Coll Cardiol. 1991;17:151A.

    Article  Google Scholar 

  72. Ko W, Gold JP, Lazzaro R, et al. Survival analysis of octogenarian patients with coronary artery disease managed by elective coronary artery bypass surgery versus conventional medical treatment. Circulation. 1992;86(Suppl II):191–7.

    Google Scholar 

  73. Mick MJ, Simpfendorfer C, Arnold AZ, et al. Early and late results of coronary angioplasty and bypass in octogenarians. Am J Cardiol. 1991;68:1316–20.

    Article  PubMed  CAS  Google Scholar 

  74. Likosky DS, Dacey LJ, Baribeau YR, et al. Long-term survival of the very elderly undergoing coronary artery bypass grafting. Ann Thorac Surg. 2008;85:1233–7.

    Article  PubMed  Google Scholar 

  75. Mamoun NF, Meng XU, Sessler DI, et al. Comparison of outcomes in older and younger patients after coronary artery bypass graft surgery. Ann Thorac Surg. 2008;85:1974–9.

    Article  PubMed  Google Scholar 

  76. Camacho M, Baran D, Martin A, et al. Improved survival in high-risk patients with smaller implantable LVAD’s: single-center experience over 3 years. J Heart Lung Transplant. 2009;28(2):S274.

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to acknowledge the invaluable assistance of Gladys Madrid RN, in the creation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Newark Beth Israel Medical Center, 201 Lyons Avenue, Suite G-5, Newark, NJ, 07112, USA

    Margarita T. Camacho

Authors
  1. Margarita T. Camacho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa L. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margarita T. Camacho .

Editor information

Editors and Affiliations

  1. , Department of Thoracic Surgery, Geisinger Wyoming Valley Medical Center, 1000 East Mountain Drive, Wilkes-Barre, 18711, Pennsylvania, USA

    Mark R. Katlic

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Camacho, M.T., Wong, M.L. (2011). Surgery for Ischemic Coronary Disease in the Elderly. In: Katlic, M. (eds) Cardiothoracic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0892-6_30

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0892-6_30

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0891-9

  • Online ISBN: 978-1-4419-0892-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation