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Off-pump coronary artery surgery in the elderly
Zile S Meharwal1, Naresh Trehan
1Department of Cardiovascular Surgery Escorts Heart Institute and Research Centre New Delhi, India. meharwal@hotmail.com
Insights
Off-pump coronary artery bypass grafting is safe for elderly patients over 70. This procedure shows reduced complications and shorter hospital stays compared to on-pump surgery.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- The choice between off-pump (OPCAB) and on-pump (traditional) CABG in elderly patients remains a subject of ongoing research.
- Elderly patients present unique challenges due to comorbidities and potential for increased surgical risk.
Purpose of the Study:
- To compare the clinical outcomes of off-pump versus on-pump coronary artery bypass grafting in patients aged 70 years and older.
- To evaluate differences in operative mortality, morbidity, and resource utilization between the two surgical techniques.
- To determine the safety and efficacy of OPCAB in a geriatric population.
Main Methods:
- A retrospective study comparing 186 patients who underwent OPCAB with 389 patients who underwent on-pump CABG.
- Patients were aged 70 years or older, and those requiring single-vessel revascularization were excluded.
- Preoperative risk factors were matched between the two groups to ensure comparability.
Main Results:
- Operative mortality was similar between groups (2.2% for OPCAB vs. 4.6% for on-pump).
- The OPCAB group demonstrated significantly better outcomes, including shorter intubation times, reduced blood loss, and lower rates of blood transfusion.
- Further benefits for OPCAB included decreased reoperation for bleeding, lower incidence of atrial fibrillation, shorter intensive care unit stays, and reduced total hospital stay.
Conclusions:
- Off-pump coronary artery bypass grafting is a safe and effective alternative for elderly patients undergoing multi-vessel revascularization.
- OPCAB is associated with significantly reduced morbidity and shorter hospitalization periods compared to on-pump CABG in this age group.
- These findings support the consideration of OPCAB for selected elderly patients to improve recovery and resource efficiency.
Abstract:
We compared the results of off-pump (n = 186) and on-pump (n = 389) coronary artery bypass grafting in elderly patients over 70 years old. Patients undergoing single-vessel revascularization were excluded from the study. The 2 groups matched in preoperative risk factors. Operative mortality was comparable (off-pump 2.2% versus on-pump 4.6%). The off-pump group fared better in intubation time (16 +/- 4 hours versus 25 +/- 5 hours), blood loss (365 +/- 58 mL versus 584 +/- 72 mL), the need for blood transfusion (31.7% versus 44%), reoperation for bleeding (0.5% versus 3.6%), atrial fibrillation (10.2% versus 18.5%), intensive care unit stay (21 +/- 8 hours versus 34 +/- 10 hours), and total hospital stay (5 +/- 2 days versus 8 +/- 3 days). Off-pump bypass surgery is thus safe for elderly patients and is associated with reduced morbidity and shorter hospitalization than on-pump surgery.