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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
[Performing off-pump coronary artery bypass grafting in elderly patients safely]
1Department of General and Cardiothoracic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Insights
Off-pump coronary artery bypass grafting (OPCAB) is safe for elderly patients over 80. Careful preoperative assessment and specialized techniques like high thoracic epidural anesthesia (TEA) and coronary artery active perfusion system (CAPS) minimize risks.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Anesthesiology
Context:
- Increasing prevalence of ischemic heart disease in elderly patients.
- Need for safe surgical options for octogenarians with coronary artery disease.
Purpose:
- To evaluate the safety and efficacy of off-pump coronary artery bypass grafting (OPCAB) in patients aged 80 years and older.
- To assess the role of high thoracic epidural anesthesia (TEA) and coronary artery active perfusion system (CAPS) in facilitating OPCAB for this demographic.
Summary:
- A study of 41 octogenarian patients undergoing OPCAB between 2001-2004.
- Preoperative screening for carotid artery stenosis and cerebral infarction was performed.
- Intraoperative use of TEA and CAPS contributed to reduced operating and intubation times, stable hemodynamics, and a bloodless field.
- No operative deaths or severe postoperative complications were reported.
Impact:
- Demonstrates that OPCAB can be safely performed in octogenarian patients.
- Highlights the benefits of TEA for bradycardia and vasodilatation, and CAPS for improved surgical conditions.
- Suggests that careful preoperative evaluation combined with specific anesthetic and perfusion techniques enhances safety in elderly cardiac surgery patients.
Abstract:
The elderly patients of the ischemic heart disease have been increasing in recent years. From January 2001 to December 2004, 41 patients were aged 80 years or older underwent off-pump coronary artery bypass grafting (OPCAB) in our hospital. To perform OPCAB of elderly patient safely, we review presence of carotid artery stenosis and previous cerebral infarction preoperatively and use high thoracic epidural anesthesia (TEA) and coronary artery active perfusion system (CAPS) intraoperatively. TEA provides bradycardia and coronary vasodilatation which facilitate beating-heart surgery technically, and prevent intra- and postoperative arrhythmia. Comparing with before use of TEA, operating time and postoperative intubation time decreased significantly. Using CAPS anastomosis was performed under bloodless field and stable hemodynamics. There was no operative death and severe postoperative complication. In conclusion, with careful preoperative inspection and using TEA and CAPS, OPCAB can be performed safely in octogenarians.
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