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Published on: November 24, 2014
[Off-pump versus conventional coronary artery bypass grafting in octogenarians]
Tsutomu Sugimoto1, K Yamamoto, S Tanaka
1Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka, Japan.
Insights
Coronary artery bypass grafting (CABG) is safe for octogenarians. Both off-pump (OPCAB) and conventional CABG (C-CABG) show good outcomes, though C-CABG achieved more complete revascularization.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) in elderly patients (≥80 years) is increasingly prevalent.
- A study cohort included 33 octogenarians undergoing CABG between 1996 and 2002.
- The study compared outcomes of off-pump CABG (OPCAB) versus conventional CABG (C-CABG) in this age group.
Purpose of the Study:
- To evaluate the clinical and short-term outcomes of OPCAB and C-CABG in octogenarian patients.
- To determine the safety and efficacy of myocardial revascularization in elderly individuals.
- To compare operative times, revascularization completeness, and postoperative complications between OPCAB and C-CABG.
Main Methods:
- Retrospective analysis of 33 patients aged 80 years or older who underwent CABG.
- Comparison of 7 OPCAB cases with 26 C-CABG cases.
- Evaluation of operative time, number of distal anastomoses, complete revascularization rates, and major postoperative complications.
Main Results:
- OPCAB had significantly shorter operation times (218 vs. 281 minutes) and fewer distal anastomoses (1.9 vs. 3.8).
- Conventional CABG achieved a significantly higher rate of complete revascularization (84.6% vs. 42.9%).
- No significant differences in major postoperative complications or hospital deaths were observed; 3-year cardiac event-free rates favored C-CABG (84.6% vs. 75%).
Conclusions:
- Coronary artery bypass grafting is a safe and effective procedure for myocardial revascularization in octogenarians.
- Both OPCAB and C-CABG can yield favorable outcomes in elderly patients.
- Complete revascularization should be pursued in most octogenarian cases, utilizing either OPCAB or C-CABG, except for high-risk individuals.
Abstract:
Coronary artery bypass grafting (CABG) in elderly patients is becoming increasingly common. From January 1996 to February 2002, 836 patients underwent CABG in our hospital, of whom 33 patients (3.9%) were aged 80 years or older. We evaluated the clinical and short-term results of 7 cases of off-pump CABG (OPCAB) and 26 cases of conventional CABG (C-CABG). Mean patient age and preoperative risk factors were similar in both groups. The OPCAB group had significantly decreased operation time (218 versus 281 minutes, p<0.05), and the number of distal anastomoses was significantly fewer in the OPCAB group than in the C-CABG group (1.9 versus 3.8, p<0.05). The frequency of complete revascularization in C-CABG was significantly higher than that of the OPCAB group (84.6% versus 42.9%, p<0.05), and there were no differences in the incidence of major postoperative complications between the groups. There was no hospital death in either group. Cumulative cardiac event free rates were 75% at 1 year and 75% at 3 years in the OPCAB group and 100% at 1 year and 84.6% at 3 years in the C-CABG group (p<0.05). In conclusion, CABG is safe and effective for myocardial revascularization in octogenarians. Except for high-risk cases, complete revascularization with OPCAB or C-CABG should be performed, because favorable outcomes can be expected even in the elderly patients.
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