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Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass
M Ricci1, H L Karamanoukian, R Abraham
1Division of Cardiothoracic Surgery and the Center for Minimally Invasive Cardiac Surgery, The Buffalo General Hospital, SUNY at Buffalo, New York 14203, USA.
Insights
Off-pump coronary artery bypass grafting in octogenarians showed significantly lower stroke and complication rates. While mortality trends were higher off-pump, the procedure offers potential benefits for elderly patients needing myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
Background:
- Myocardial revascularization in elderly patients carries higher risks.
- Octogenarians face increased morbidity and mortality with traditional procedures.
Purpose of the Study:
- To evaluate the benefits of off-pump coronary artery bypass grafting (CABG) in octogenarians.
- To compare outcomes of off-pump CABG versus conventional CABG with cardiopulmonary bypass (CPB) in this age group.
Main Methods:
- Retrospective analysis of 269 octogenarians undergoing CABG.
- Comparison of 172 patients with CPB versus 97 patients without CPB (off-pump group).
- Data collected included demographics, risk factors, complications, and outcomes.
Main Results:
- Off-pump group had a significantly higher proportion of reoperations (16.5% vs 4.7%).
- Significantly fewer postoperative complications (85.6% vs 75%) and zero stroke incidence in the off-pump group.
- No significant difference in 30-day or risk-adjusted mortality, with a trend towards higher rates in the off-pump group.
Conclusions:
- Off-pump CABG in octogenarians is associated with significantly lower perioperative stroke and overall complication rates.
- The study suggests potential benefits for elderly patients undergoing off-pump myocardial revascularization, despite a trend towards higher mortality.
Background:
Myocardial revascularization in elderly patients is associated with a morbidity and a mortality substantially higher than those observed in younger patients. The aim of this study was to analyze the potential benefits of coronary artery bypass grafting without cardiopulmonary bypass (CPB) for octogenarians.
Methods:
Of 269 octogenarians who underwent coronary artery bypass grafting at our institution between January 1995 and May 1999, 172 had the operation with CPB (CPB group) and 97, without CPB (off-pump group). Revascularization of the circumflex system or right coronary artery were not considered contraindications to off-pump grafting. Demographic data, preoperative risk factors, comorbid conditions, angiographic findings, postoperative complications, and outcomes were compared.
Results:
The groups were comparable for age, sex, Canadian Cardiovascular Society class, operative priority (elective, urgent, or emergent), preoperative risk factors, and left ventricular ejection fraction. A significantly higher proportion of reoperations was observed in the off-pump cohort (16 of 97, 16.5%) compared with the CPB cohort (8 of 172, 4.7%) (p = 0.002). There was a trend toward a higher graft-patient ratio in the CPB group (3.3 versus 1.8; p = not significant). Freedom from postoperative complications was significantly higher in the off-pump group than in the CPB group (83 of 97, 85.6%, versus 129 of 172, 75%; p = 0.04). The incidence of stroke was 0% in the off-pump cohort compared with 9.3% (16 of 172) in the CPB cohort (p < 0.0005). Although there was a trend toward higher 30-day and risk-adjusted mortality rates in the off-pump group than in the CPB group (10.3% versus 5.2% and 2.8% versus 1.8%, respectively), the differences were not significant. The length of hospitalization was slightly lower in the off-pump group (9.1 versus 10.8 days; p = not significant).
Conclusions:
This investigation suggests that patients 80 years of age and older undergoing off-pump coronary artery bypass grafting can experience significantly lower rates of perioperative stroke and overall complications compared with those undergoing the same procedure with CPB, although a trend toward higher mortality rates was observed in the off-pump group.