Morbidity and mortality of coronary artery surgery after the age of 70 years.

From January, 1977, to December, 1983, 102 patients aged 70 years or more underwent isolated aortocoronary bypass surgery. They were compared with a group of 100 consecutive patients of less than 70 years of age who underwent the same surgical procedure in 1983. The older group was consistently more diseased in regard to clinical incapacity, unstable angina, the number of coronary arteries involved, and the number of coronary bypasses performed. The incidence of substantial stenosis of the left main coronary artery among the older patients was twice that in the younger ones. There were 7 early deaths in the older group and none in the younger patients. The cause of death was cardiac in 3 patients and noncardiac in 4. A total of 54 complications occurred in 39 older patients and 32 in 27 younger patients. The incidence of cardiac complications was similar in both groups (18 in the older and 17 in the younger). However, noncardiac complications were significantly (p less than 0.0001) more common in older patients (32) than in the younger patient group (7). The most frequent in the older group were cerebral (14), sternal (6), and respiratory (5) complications. Thus, the operative risk of aortocoronary bypass grafting is increased after the age of 70 years, particularly because of noncardiac complications, which are responsible for more than half of the early deaths. Careful selection of candidates for surgical treatment in this age group is mandatory, and particular attention should be given preoperatively to the search for noncardiac disorders to decrease the incidence of these operative complications.