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Myocardial revascularization in the elderly using beating heart coronary artery bypass surgery
T C Koutlas1, J R Elbeery, J M Williams
1Division of Cardiothoracic Surgery, East Carolina University, School of Medicine, Greenville, North Carolina 27858-4354, USA. tkoutlas@brody.med.ecu.edu
Insights
Off-pump coronary artery bypass (OP-CAB) is a safe and effective myocardial revascularization technique for elderly patients. This approach demonstrated no deaths and reduced hospital stays compared to traditional bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Minimally Invasive Cardiac Procedures
Background:
- Off-pump coronary artery bypass (OP-CAB) reduces complications associated with cardiopulmonary bypass (CPB).
- The effectiveness of OP-CAB in elderly patients (≥75 years) requires further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of OP-CAB in elderly patients.
- To compare OP-CAB outcomes with standard coronary artery bypass grafting (CABG) using CPB in this demographic.
Main Methods:
- Retrospective analysis of 53 patients aged 75+ undergoing OP-CAB (January 1996 - October 1999).
- Comparison with 220 patients who underwent traditional CABG with CPB during the same period.
- Data collected included perioperative outcomes and postoperative complications.
Main Results:
- Both groups had similar mean ages (79 years) and preoperative risk factors.
- No significant differences in postoperative myocardial infarction, atrial fibrillation, bleeding, neurological, or renal complications.
- OP-CAB group showed zero mortality versus 7.6% in the CABG group (p<0.05), shorter hospital stays (4.4 vs. 8.4 days), and lower transfusion needs (0.4 vs. 1.9 units PRBCs).
Conclusions:
- OP-CAB is a safe and effective myocardial revascularization strategy for elderly patients.
- OP-CAB may be a preferred option for eligible elderly individuals undergoing coronary artery bypass surgery.
Background:
Beating heart or "off-pump" coronary artery bypass (OP-CAB) has become an accepted method of myocardial revascularization by reducing the perioperative morbidity related to cardiopulmonary bypass (CPB). However, the efficacy of OP-CAB has not been well established in the elderly patient population.
Methods:
OP-CABs were performed in 53 patients aged 75 years and older, at Pitt County Memorial Hospital from January 1996 to October 1999, either through a median sternotomy or an anterior thoracotomy. These results were compared with 220 patients who underwent standard coronary artery bypass graft (CABG) operation using CPB during the same time period.
Results:
Mean patient age for both groups was 79+/-0.5 years and preoperative risk factors were similar. There were no differences in postoperative myocardial infarction, atrial fibrillation, bleeding, neurologic complications, or renal failure. There were no deaths after OP-CAB, compared with the 7.6% operative mortality rate after CABG (p<0.05). The OP-CAB group had a significantly shorter postoperative length of stay (4.4+/-0.4 days vs. 8.4+/-0.6 days) and lower transfusion requirements (0.4+/-0.1 units packed red blood cells vs 1.9+/-0.2 units packed red blood cells) than the CABG group.
Conclusions:
Our data demonstrate that OP-CAB is a safe and efficacious method of myocardial revascularization in the elderly, and may actually be preferential in these patients when applicable.
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