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Target vessel revascularization without cardiopulmonary bypass in elderly high-risk patients
1Department of Cardiothoracic Surgery, Vienna General Hospital, University of Vienna, Austria.
Insights
Coronary artery bypass grafting without cardiopulmonary bypass (CPB) in older patients significantly reduces perioperative mortality and complications. This approach offers a promising option for selected high-risk individuals, despite potentially incomplete revascularization.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery bypass grafting (CABG) in patients over 75 carries high operative risks.
- Off-pump CABG is a potential alternative for select elderly patients, but outcomes require further investigation.
Purpose of the Study:
- To compare the outcomes of CABG with and without cardiopulmonary bypass (CPB) in patients aged 75 years and older.
- To evaluate perioperative risk, midterm survival, and quality of life in these patient groups.
Main Methods:
- A retrospective analysis of 44 patients over 75 undergoing CABG, matched for preoperative risk and left ventricular function.
- Comparison between groups who underwent CABG with CPB versus off-pump CABG.
- Assessment of patient characteristics, risk scores (Parsonnet, EuroSCORE), perioperative outcomes, midterm survival, and quality of life (sf36).
Main Results:
- Off-pump CABG was associated with significantly lower perioperative mortality (4.5% vs. 15.9%, p=0.0226).
- Patients undergoing on-pump CABG received more grafts and were more likely to achieve complete revascularization (100% vs. 63.6%, p=0.0010).
- Off-pump CABG showed fewer perioperative complications and better midterm survival (log rank p=0.0228), with comparable quality of life.
Conclusions:
- Incomplete target vessel revascularization of the culprit lesion is a viable strategy for selected high-risk elderly patients.
- Off-pump CABG offers a significant reduction in perioperative mortality and improved midterm outcomes in this population.
Background:
Coronary artery bypass grafting in patients over 75 years is associated with high operative risk. Target vessel revascularization without cardiopulmonary bypass is a promising option for highly selected, older patients. However, the outcome remains uncertain.
Methods:
We investigated 44 patients over 75 years, matched for preoperative risk and left ventricular function, who underwent coronary artery bypass grafting either with or without cardiopulmonary bypass (CPB). We analyzed patients characteristics, Parsonnet score, EuroSCORE, short as well as midterm outcome and quality of life (freedom from recurrence of angina, anti-anginal therapy, sf36 test).
Results:
Perioperative mortality was higher in the patient group operated with CPB (15.9) as compared to patients operated without CPB (4.5%, p = 0.0226). Patients operated with cardiopulmonary bypass received more grafts (3.1 +/- 0.1) than patients operated without cardiopulmonary bypass (1.6 +/- 0.1, p = 0.0001) and and were more likely to undergo complete revascularization (with CPB 100%, without CPB 63.6%, p = 0.0010). Perioperative complications were more frequent and midterm survival was worse in the patient group operated with CPB (log rank p = 0.0228). Quality of life was comparable in both groups.
Conclusions:
The concept of incomplete target vessel revascularization of the culprit lesion seems to be a promising option for selected high-risk patients, predominantly due to lower perioperative mortality.