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Off-pump technique in coronary artery bypass grafting in elderly patients
Chih-Yuan Lin1, Gou-Jieng Hong, Kou-Chen Lee
1Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Insights
Off-pump coronary artery bypass grafting (CABG) is a safe and effective option for patients over 80. This beating heart technique offers promising short-term outcomes, making it preferable for elderly individuals needing myocardial revascularization.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) is linked to significant risks in elderly patients.
- Evaluating alternative surgical techniques is crucial for improving outcomes in this demographic.
Purpose of the Study:
- To assess the feasibility of beating heart coronary artery revascularization in patients aged 80 years and older.
- To compare the outcomes of off-pump CABG with conventional on-pump CABG in octogenarians.
Main Methods:
- Retrospective chart review of 17 patients aged over 80 who underwent isolated off-pump CABG.
- Comparison with 12 patients who underwent conventional CABG with CPB during the same period (July 1999 - December 2000).
- Analysis of demographic data, operative details, postoperative results, and short-term outcomes.
Main Results:
- The off-pump group (mean age 82.2 years) showed no stroke, myocardial infarction, re-bleeding, or renal failure.
- Significantly shorter intubation times (10.6 vs 48.4 h), ICU stays (2.9 vs 4.2 days), and postoperative stays (12.7 vs 18.1 days) in the off-pump group.
- No mortality in the off-pump group versus one death in the on-pump group.
Conclusions:
- Off-pump CABG is a safe and effective myocardial revascularization method for elderly patients (≥80 years).
- The beating heart technique demonstrates promising short-term outcomes in this population.
- Off-pump CABG is suggested as a preferable approach for octogenarian patients undergoing coronary artery bypass surgery.
Background:
The use of cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) is associated with substantial morbidity and mortality, especially in the elderly. The purpose of this study was to evaluate the feasibility of beating heart coronary artery revascularization in patients aged at least 80 years.
Methods:
A retrospective chart review was carried out for 17 patients aged over 80 years who underwent isolated off-pump CABG at the Tri-Service General Hospital, Taiwan, during the period July 1999 to December 2000. The demographic characteristics, operative data, postoperative results and short-term outcomes of patients were compared with those of 12 patients who underwent conventional CABG using CPB during the same time period.
Results:
The off-pump group consisted of 13 men and four women with a mean age of 82.2 +/- 0.9 years and an ejection fraction of 53.4 +/- 4.1%. The on-pump group consisted of eight men and four women with a mean age of 83.5 +/- 0.5 and an ejection fraction of 42.0 +/- 4.8%. The mean number of anastomoses performed per patient was 3.1 +/- 0.3 in the off-pump group and 3.0 +/- 0.14 in the on-pump group. There was no occurrence of stroke, myocardial infarction, re-entry for bleeding or renal failure among patients in the off-pump group. Intubation time (10.6 vs 48.4 h), intensive care unit stay (2.9 vs 4.2 days) and postoperative stay (12.7 vs 18.1 days) were significantly shorter in the off-pump group than in the on-pump group. No patient died in the off-pump group, whereas one patient died in the on-pump group.
Conclusions:
The results of this study suggest that the off-pump technique is a safe and efficacious method for myocardial revascularization in elderly patients and that the short-term outcome obtained with this technique are promising. Our data suggest that the off-pump technique is preferable in these patients.