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Published on: September 15, 2023
Off-pump coronary artery bypass grafting using only arterial grafts in elderly patients
Kaoru Matsuura1, Junjiro Kobayashi, Osamu Tagusari
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Insights
Off-pump coronary artery bypass grafting with arterial grafts is safe for elderly patients. This procedure demonstrated comparable outcomes to younger patients, indicating its feasibility in older populations.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Vascular Grafting
Background:
- Elderly patients present unique challenges for cardiac surgery.
- Arterial grafts offer potential long-term benefits in coronary artery bypass grafting.
- Assessing the safety and feasibility of off-pump coronary artery bypass grafting (OPCAB) with arterial grafts in the elderly is crucial.
Purpose of the Study:
- To evaluate the safety and feasibility of OPCAB using exclusively arterial grafts in elderly patients (≥75 years).
- To compare outcomes between elderly (E) and younger (Y) patient groups undergoing OPCAB with arterial grafts.
Main Methods:
- Retrospective analysis of 653 patients undergoing OPCAB from 2000-2003.
- 581 patients received only arterial grafts.
- Patients were stratified into an elder group (E, ≥75 years, n=111) and a younger group (Y, <75 years, n=470).
- Mean follow-up was 21 months.
Main Results:
- Elderly patients had higher predicted surgical risk (EuroSCORE).
- Graft patency rates were similar (E: 98.7% vs. Y: 97.8%).
- Major adverse cardiac events and hospital mortality showed no significant difference between groups (p>0.99 and p=0.095, respectively), with deaths unrelated to cardiac events.
Conclusions:
- OPCAB with arterial grafts is a safe and feasible option for elderly patients.
- Outcomes in elderly patients are comparable to those in younger patients.
- This approach supports the use of arterial grafts in older individuals undergoing OPCAB.
Background:
This study aimed to elucidate the safety and feasibility of off-pump coronary artery bypass grafting with only arterial grafts for elderly patients.
Methods:
Of 653 patients who underwent off-pump coronary artery bypass grafting from April 2000 to December 2003, 581 patients did so with only arterial grafts. The average age was 66.9 +/- 9.3 years. The patients were divided into the elder group E (75 years old or more: 111 cases) or the younger group Y (younger than 75 years old: 470 cases). The mean follow-up term was 21 +/- 12 months.
Results:
Additive and logistic EuroSCOREs of group E were significantly higher than those of group Y (p < 0.0001). The number of bypass grafts was 3.3 +/- 0.9 in group E and 3.3 +/- 1.1 in group Y (p = 0.43). The proportion of total revascularization was 74% (82 of 111) in group E and 80% (377 of 470) in group Y (p = 0.15). The number of bilateral implementations of internal thoracic artery was 10 (9.0%) in group E and 196 (42%) in group Y (p < 0.0001). The graft patency rate was 98.7% in group E and 97.8% in group Y (p = 0.96). Hospital mortality was 2.7% (3 of 111) in group E and 0.2% (1 of 470) in group Y (p = 0.095). The causes of death were unrelated to cardiac events. Major adverse cardiac events occurred in 5 patients (5.1%) in group E and in 24 patients (5.6%) in group Y (p > 0.99).
Conclusions:
Off-pump coronary artery bypass grafting using only arterial grafts in elderly patients is as safe and feasible as in young patients.
