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Heart, Lung and Circulation S212007;16:S13–S29 ORAL PRESENTATIONS

Table 1. Pre-, Intra- and Postoperative Parameters by Age

70–74 years (n = 547) 75–79 years (n = 349) >80 years (n = 135) p-value

Euroscore corrected for age 2 2 3 nsInfarct < 90 days 14.8% (81) 21.5% (75) 28.9% (39) 0.001Three vessel disease 80.1% (438) 87.1% (304) 91.9% (124) 0.03Left mainstem stenosis 33.3% (182) 42.1% (147) 45.9% (62) 0.004Unstable coronary disease 25.6% (140) 33.8% (118) 47.4% (65) 0.001Impaired left ventricular function 26.5% (145) 30.1% (105) 32.6% (44) nsMean number of grafts 3.02 3.10 3.27 nsMultiple arterial grafts 38.6% (211) 27.5% (96) 23.7% (32) 0.02Median ITU stay in days (IQR) 1 (1–2) 1 (1–2) 1 (1–2) nsPostoperative renal failure 2.7% (15) 4.6% (16) 3.0% (4) nsPostoperative stroke 2.0% (11) 2.0% (7) 0.7% (1) nsProlonged ventilation (>5 days) 0.9% (5) 2.3% (8) 0.7% (1) nsAny non-fatal complication 15.7% (86) 20.1% (70) 26.7% (36) 0.00830-day mortality 1.1% (6) 2.9% (10) 2.2% (3) ns

grafting with regard to graft patency, target vessel revas-cularisation and long-term survival are well documented.It is less clear whether this benefit is also imparted inpatients requiring operation in an emergency setting. Weaimed to quantify the impact of the left internal mam-mary artery on hospital and long-term outcomes in thesepatients.

Methods. Data were collected prospectively on 203 con-secutive patients aged between 40 and 88 years, whounderwent isolated emergency coronary artery bypassgrafting between 1992 and 2005. Emergency surgery wasdefined as a requirement for operation within 24 h ofpresentation. Mean follow-up (±standard deviation) was74 ± 39 months with a total of 1210 patient-years.

Results. The left internal mammary artery (LIMA) wasused in 91 patients (45%), the remaining 113 patients(55%) received saphenous vein grafts only (SVG). Overallhospital mortality was 6.4 ± 3.4% (±95% confidence inter-val). Univariate analyses found patients receiving the leftinternal mammary artery had significantly lower hospi-tal mortality 2.2% vs 9.8% (p < 0.03). The LIMA group alsohad a reduced requirement for intra-aortic balloon pump(IABP) support in order to successfully separate from car-diopulmonary bypass (p < 0.01). The use of the left internalmammary artery reduced the requirement for postopera-tive inotropic (p < 0.05) or IABP support (p < 0.05).

Of the 190 hospital survivors there were 45 late deaths.To(tdsvfyS

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CORONARY REVASCULARISATION IN OCTO-GENARIANS: IS AGE JUST A NUMBER?

Philip Hayward 1, Gunaratnam Niranjan 1,2, Oswaldo

Valencia 2, Venkatachalam Chandrasekaran 2, RobinKanagasabay 2

1 Austin Hospital, Heidelberg, Victoria, Australia2 St Georges Hospital, London, United Kingdom

Introduction. Coronary surgery in octogenarians mayinvoke perceptions of higher perioperative risk andgreater comorbidity. We sought to establish whether ourexperience justifies any age related concerns.

Methods. Retrospective analysis of prospectively com-piled pre-, peri- and postoperative data from 2737 patientsundergoing isolated coronary surgery over a 4-yearperiod. Data were analysed comparing three age groups(70–74, 75–79, >80 years) comprising 547, 349 and 135 con-secutive patients, respectively.

Results. Most preoperative risk factors for periopera-tive mortality or complications did not differ significantlybetween age groups (exceptions noted in Table 1). Therewere no significant operative differences other than lowerusage of multiple arterial grafts in octogenarians. Use ofoff-pump technique did not differ significantly betweenage groups (41, 40 and 47% of cases). Postoperative mor-tality did not increase with age (1.1, 2.9 and 2.2%; p = ns),and medians of postoperative stay range from 6 to 8 days(dwtpp

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he use of only saphenous vein grafts was a predictorf late death (p < 0.01). Excluding hospital deaths survivalKaplan-Meier) was improved in patients who receivedhe left internal mammary artery to the left anteriorescending artery. This, however, failed to reach statisticalignificance (log rank analysis p = 0.08). At five years sur-ival was 87% if the LIMA was used compared with 75%or patients receiving saphenous vein grafts only. At eightears survival was 77% in the LIMA group vs 69% for theVG group.Discussion. In emergency coronary artery bypass graft-

ng the use of the left internal mammary artery to the leftnterior descending artery is associated with a reducedequirement for inotropic or intra-aortic balloon pumpupport, reduced hospital mortality, and a trend towardsmproved long-term survival.

oi:10.1016/j.hlc.2007.02.024

p < 0.001). There was no significant increase in the inci-ence of any single complication, although octogenariansere more likely overall to sustain a non-fatal complica-

ion (p = 0.008). On logistic regression analysis, age > 80, onump technique and unstable angina were independentredictors of non-fatal complication.Discussion. The higher incidence of recent infarction,

rgent operation, left mainstem and multivessel diseasemong octogenarians might imply some bias against lessressing cases in this age group. Outcomes, however,

ndicate that octogenarians do not necessarily carry unac-eptable risk, and equivalent mortality can be achievedith only a modest increase in hospital stay and compli-

ations. The effect of off-pump technique in octogenarianserits further investigation.

oi:10.1016/j.hlc.2007.02.025