The clinical outcome of off-pump coronary artery bypass surgery in the elderly patients (original) (raw)
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Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?
The Journal of Thoracic and Cardiovascular Surgery, 2011
Objective-Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass.
On-Pump and Off-Pump Coronary Artery Bypass Grafting in the Elderly: Predictors of Adverse Outcome
Journal of Cardiac Surgery, 2001
AesTRAcT Objective: To establish the role t h a t coronary artery bypass grafting (CABGI without cardiopulmonary bypass (CPB) may have i n improving perioperative outcomes of patients 70 years of age and older. Background: Coronary revascularization in elderly patients is associated with morbidity and mortality rates higher than those observed in younger patients. The impact of CABG without CPB on perioperative outcomes has not been clearly established. Methods: This retrospective, nonrandomized study consisted of 1872 CABG patients. Of these, 1389 underwent CABG with CPB (CPB group) and 483 patients underwent CABG without CPB (off-pump group). Preoperative variables and outcomes were compared between the two groups. Multivariate logistic regression analysis was used t o identify independent predictors of mortality, stroke, and adverse outcome. Results: Demographics, Canadian Cardiovascular Society staging, operative priority, and other preoperative variables were comparable between the t w o groups. The prevalence of previous myocardial infarction was higher in the CPB group (62.6% vs 56.7%; p < 0.0051, whereas the prevalence of calcified aorta and preoperative renal failure were higher in the off-pump group (5.4% vs 9.5%; p = 0.04 and 1.7% vs 3.3%; p = 0.04, respectively). Although the graft/patient ratio was higher in the CPB group (3.4 vs 1.91, these patients displayed more extensive coronary artery involvement. A t univariate analysis, patients in the off-pump group had a higher rate of freedom from complications (88.2% vs 81.3%; p e 0.0051 and a lower incidence of stroke (2.1% vs 4.2%; p = 0.034) than patients in the CPB group. Although there was a trend for a higher actual mortality in the off-pump group (4.8% vs 3.7%; p = ns), the risk adjusted mortality in this group was lower (1.9% vs 2.1%). Multivariate analysis showed that while the use of CPB correlated independently with an increased risk of overall complications, it was not associated with a higher probability of death or stroke. Conclusions: This investigation suggests t h a t elderly patients undergoing CABG may benefit from off-pump revascularization, as the use of CPB correlated independently with an increased risk of overall complications. However, CPB did not emerge as an independent predictor of death or stroke at multivariate analysis. fJ
European Journal of Cardio-thoracic Surgery, 2003
Objective: Although there has been some evidence supporting the theoretical and practical advantages of off-pump coronary artery bypass (OPCAB) over the conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB), it has not yet been determined which group of patients would benefit most from it. It has been advocated recently that high-risk patients could benefit most from avoidance of CPB. The aim of this retrospective study is to assess the efficacy of the OPCAB technique in multi-vessel myocardial revascularization in a large series of high-risk patients. Methods: The records of 1398 consecutive high-risk patients who underwent primary isolated CABG at Harefield Hospital between August 1996 and December 2001 were reviewed retrospectively. Patients were considered as high-risk and included in the study if they had a preoperative EuroSCORE of $5. Two hundred and eighty-six patients were operated on using the OPCAB technique while 1112 patients were operated on using the conventional CABG technique with CPB. The OPCAB patients were significantly older than the CPB patients (68.1^8.3 vs. 63.7^9.9 years, respectively, P , 0:001). The OPCAB group included significantly more patients with poor left ventricular (LV) function (ejection fraction (EF) #30%) (P , 0:001) and more patients with renal problems (P , 0:001). Results: There was no significant difference in the number of grafts between the groups. The CPB patients received 2.8^1.2 grafts per patient while OPCAB patients received 2.8^0.5 grafts per patient (P ¼ 1). Twenty-one (7.3%) OPCAB patients had one or more major complications, while 158 (14.2%) CPB patients (P ¼ 0:008) developed major complications. Thirty-eight (3.4%) CPB patients developed peri-operative myocardial infarction (MI) while only two (0.7%) OPCAB patients developed peri-operative MI (P ¼ 0:024). The intensive therapy unit (ITU) stay for OPCAB patients was 29.3^15.4 h while for CPB patients it was 63.6^167.1 h (P , 0:001). There were ten (3.5%) deaths in the OPCAB patients compared to 78 (7%) deaths in the CPB patients (P ¼ 0:041) within 30 days postoperatively. Conclusions: This retrospective study shows that using the OPCAB technique for multi-vessel myocardial revascularization in high-risk patients significantly reduces the incidence of peri-operative MI and other major complications, ITU stay and mortality. Even though the OPCAB group included a significantly higher proportion of older patients with poor LV function (EF #30%) and renal problems, the beneficial effect of OPCAB was evident. q
European Journal of Cardio-Thoracic Surgery, 2002
Objective: To investigate the influence of age and modern techniques of coronary artery bypass grafting with or without cardiopulmonary bypass on early and mid-term mortality and morbidity in a consecutive series of elderly patients. Methods: From April 1996 to December 2000, data of 3842 patients undergoing coronary revascularisation were prospectively entered into a database. Data were extracted for 990 patients older than 70 years: (A) 70-74 years, (n ¼ 659); (B) 75 or more years, (n ¼ 331). Results: A total of 990 elderly patients ($70 years) underwent coronary revascularisation, 219 (22.1%) with off-pump surgery. Elderly patients were more likely to have higher CCS, NYHA and EuroScores, history of previous MI, unstable angina, renal dysfunction, left main stem disease $50%, and to be urgent. However, they were less likely to be overweight. In-hospital mortality, occurrence of re-intubation, renal dysfunction, and hospital stay were significantly higher in this elderly group. Overall, the distribution of mortality was doubled in the female gender although this was not statistically significant. Patients undergoing on-pump surgery had lower EuroScore, were less likely to be .75 years of age, likely to have obesity or hypercholesterolaemia, or to have suffered a previous cerebro-vascular accident. However, they had more extensive coronary disease, were more likely to have unstable angina, and received more grafts than those undergoing off-pump surgery. After adjustment for prognostic variables, off-pump surgery was found to be associated with reduced inotropic use, intra-operative arrhythmias, blood loss and transfusion requirement when compared to on-pump coronary surgery (point estimates of odd ratios, 0.26-0.87) (all P , 0:05). Mid-term mortality or cardiac-related events were similar in the two groups. Conclusions: Early but not mid-term mortality is higher in patients aged 75 or more years when compared with those aged 70-74 years. Off-pump coronary artery bypass surgery is safe and effective in the elderly population. q
Journal of International Medical Research, 2009
The results of on-pump coronary artery bypass graft (CABG) surgery in 166 high-risk elderly patients (EuroSCORE 6 or more; over age 65 years [mean 71.8 years]) were compared with 176 low-risk elderly patients (EuroSCORE below 6; over age 65 years [mean 68.8 years]). There was no significant difference in hospital mortality or number of grafts between the two groups. Rates of inotropic agent use, intra-aortic balloon pump insertion and atrial fibrillation, and the duration of intensive care unit and hospital stay were significantly higher in high-risk than low-risk patients. There were no significant differences in the incidence of major complications between the two groups. The results suggest that, in selected patients, on-pump CABG can be safely performed in high-risk patients over 65 years old with no effect on mortality.
Impact of coronary artery bypass grafting in elderly patients
Revista Brasileira de Cirurgia Cardiovascular, 2013
Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients ≥ 65 years-old. Methods: Patients undergoing isolated on-pump CABG from December 1 st 2010 to July 31 th 2012 were divided in two groups: GE (elderly ≥ 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation-MV-and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization. Results: In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age ≥ 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors. Conclusion: This study suggests that patients ≥ 65-yearold were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.
Revista española de anestesiología y reanimación, 2017
Introduction: We aim to describe our experience in coronary artery bypass graft in elderly patients older than 80 years and assess the associated risk and predictors of mortality in this subgroup. Material and method: From January 1999 to June 2013, 3097 patients underwent consecutive coronary artery bypass graft surgery. Patients aged over 80 years were identified. Multivariate survival analysis using Cox's regression model was performed. Results: We identified 99 patients older than 80 years (80-group; mean age 82 ± 3.5 years) and 2957 younger than 80 years (control group) (mean age 64.2 ± 9.7 years). Additive EuroSCORE was 8.4 ± 4.8 and 4.6 ± 4.6 (p < 0.001) in the 80-group vs. control group, respectively. Off-pump coronary artery bypass graft was performed in 79.6 vs. 41.6% (p < 0.001) in the 80-group vs. the control group, respectively. There was significantly higher 30 day-mortality in the 80-group, 11.2 vs. 3.3%, respectively (p < 0.001). Patients in the 80-group underwent reintervention for bleeding more frequently (9.2 vs. 2.9%; p = 0.001) and had a higher incidence of major cardiovascular complications than the control group (6.1 vs. 2.1%; p = 0.001). Independent predictors of mortality for the 80-group were: reoperation for bleeding (HR 5.7; 95% CI 1.6-19.5) and cardiovascular complications (HR 3.7; 95% CI 1.1-12.2). The mean follow-up was 6.3 ± 4.2 years for the octogenarian group. The cumulative survival of these patients was 65.7% during the study period.