Age limit for coronary bypass , CABG in nonagenarian? When not to operate?
You can operate on the patient. But you say the patient is non-ambulatory. Standing up and ambulation is necessary for pulmonary functions.
I would go for stenting of the LMCA in a non-ambulatory, old age patient.
Not sufficient clinical inputs to answer your question. Patient possibly needs intervention - PCI versus CABG is the moot question. We should calculate clinical or Syntax II score and if high (>33) then CABG should be done otherwise PCI is a good option. Where is the location of LM lesion, type of lesion, associated distal disease, Diabetes, angulation of Circumflex etc etc are all important and should be factored in decision making.
I think it would be appropriate to look at is it Benefit or Burden?
Holistic assessment would identify the trajectory of frailty on this person and if already bed and chair fast or close to moribund state? what is the advanced care directive they have chosen.
Geriatric atrophy will play a big impact if the patient has co morbidity in 2 or more facets of frailty.. One being mobility and examine the SPICES tool. Good nursing process here would be recommended as choosing a palliative approach will improve the quality of life the person is receiving whilst planning the end of life pathway.
Shocking to the medical node of colleagues, however we cant live forever and what quality to we want in the end???
There are retrospective studies regarding cardiac surgery in octogenarians and nanogenarians. One can operate 90 years old with high risks for complications. I would suggest PCI & medicine for this patient in stead of CABG.
If the Heart team or the patient still wishes by pass, then LIMA to LAD via left hemisternotomy(J-OPCAB) is an alternative.The patient is non-ambulatory, 90 yr. old, moderately reduced EF bears very high risk for respiratory, cereberovascular and would complications.
Sincerely yours,
Dr. Khalil Ahmad, Aarhus University Hospital, Denmark
Comorbidity, Frailty assessment, Medications and patient's views should be consider along with the age, I believe. Here is a presentation from BGS meeting,
http://www.bgs.org.uk/powerpoint/16spring/sharma_vishal_chest_pain.pdf
Sincerely
Thu
- Badges
- Science topic
- Similar topics
- Geoscience
- Asia
- India