Redo coronary artery bypass grafting with and without cardiopulmonary bypass in the elderly
Martin Czerny1, Daniel Zimpfer, Juliane Kilo
1Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria. michael.grimm@akh-wien.ac.at
Insights
Redo coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) in elderly patients showed a trend toward fewer major adverse cardiac events. This minimally invasive approach may be a promising option for high-risk redo CABG surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Elderly patients undergoing redo coronary artery bypass grafting (CABG) face increased morbidity and mortality risks.
- Conventional redo CABG often involves extensive tissue dissection and cardiopulmonary bypass (CPB).
Purpose of the Study:
- To compare outcomes of minimal tissue dissection and target vessel revascularization without CPB versus standard redo CABG with CPB in elderly patients (>75 years).
Main Methods:
- Retrospective analysis of 47 patients undergoing elective redo CABG.
- Comparison between 31 patients with CPB and 16 patients without CPB.
- Follow-up endpoints included survival, angina recurrence (CCS score), rehospitalizations, reinterventions, and antianginal medication use.
Main Results:
- No significant differences in perioperative deaths, nonfatal myocardial infarction, or major adverse cardiac events between groups (P > 0.058).
- Comparable rates of angina recurrence (16% vs 13.3%), nitrate use (8.7% vs 14.3%), and survival (89% vs 93%).
- A trend towards lower major adverse cardiac events in the no-CPB group was observed.
Conclusions:
- Target vessel revascularization without CPB demonstrated a trend towards fewer major adverse cardiac events in high-risk elderly patients undergoing redo CABG.
- This minimally invasive approach appears promising for long-term outcomes.
- Further research is warranted to confirm the long-term benefits of this technique in elderly patients undergoing redo CABG.
Objectives:
Morbidity and mortality rates rise with increasing age in patients undergoing conventional redo coronary artery bypass grafting (CABG). The aim of this study was to compare our experience of minimal tissue dissection and target vessel revascularization without cardiopulmonary bypass (CPB) with the standard procedure of total dissection of the heart and complete revascularization with CPB for a population of elderly patients undergoing elective redo coronary artery CABG.
Methods:
We retrospectively analyzed morbidity, mortality, and functional status of 47 patients older than 75 years who underwent redo CABG between January 1995 and June 2002. Thirty-one patients underwent redo CABG with CPB, and 16 patients underwent redo CABG without CPB. Follow-up end points were defined by patient survival, freedom from recurrence of angina (Canadian Cardiovascular Society [CCS] score), freedom from rehospitalizations and reinterventions, and the need for antianginal medication.
Results:
There were 2 perioperative deaths (2 in the CPB group versus 0 in the group without CPB; P =.151). Nonfatal myocardial infarction occurred in 3 patients (3 in the CPB group versus 0 in the group without CPB; P =.082). Major adverse cardiac events occurred in 5 patients (5 in the CPB group versus 0 in the group without CPB; P =.058). At the time of follow-up, the mean CCS score of patients who underwent redo CABG with CPB was 1.5 +/- 0.8 and was 1.6 +/- 0.7 for patients who underwent redo CABG without CPB (P =.432). The rates of angina recurrence (16% with CPB versus 13.3% without CPB; P =.243), use of nitrates (8.7% with CPB versus 14.3% without CPB; P =.542), and survival (89% with CPB versus 93% without CPB; P =.238) were very comparable for the two groups.
Conclusions:
In this high-risk subgroup of patients, those patients who underwent target vessel revascularization without CPB showed a trend toward a lower rate of major adverse cardiac events, and this procedure seems promising with regard to long-term outcome. Therefore, target vessel revascularization may be offered liberally to elderly patients who are at high risk in surgeries involving complete revascularization with CPB. Further studies are needed to elucidate the long-term outcome of target vessel revascularization for elderly patients undergoing redo CABG.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
