Aorta no-touch off-pump coronary artery revascularization in octogenarians: 5 years' experience
Sotirios N Prapas1, Ioannis A Panagiotopoulos, Dimitar N Pentchev
1Department of Cardiac Surgery, Henry Dunant Hospital, Mesoghion 107, Athens GR 11521, Greece. sprapas@dunanthospi.gr
Insights
The pi-circuit technique for off-pump coronary artery bypass (OPCAB) surgery is effective for octogenarians. While older patients experience more early complications, long-term survival rates are similar to younger patients.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Minimally Invasive Cardiac Surgery
Background:
- Ischemic heart disease affects approximately 18% of octogenarians.
- Coronary revascularization in the elderly is increasingly common but raises concerns about outcomes.
- Off-pump coronary artery bypass (OPCAB) with the pi-circuit technique is being evaluated for its efficacy in octogenarians.
Purpose of the Study:
- To assess the impact of age on morbidity and mortality in patients undergoing OPCAB using the pi-circuit procedure.
- To compare outcomes between octogenarians (>= 80 years) and younger patients (< 80 years) undergoing OPCAB.
- To evaluate long-term survival rates following OPCAB in elderly patients.
Main Methods:
- A cohort of 1359 patients undergoing isolated coronary revascularization with the pi-circuit technique (beating heart, OPCAB, no aortic manipulation, composite grafts, arterial revascularization) from 2001-2005.
- Patients were divided into two groups: >= 80 years (n=62) and < 80 years (n=1297).
- Comparison of preoperative risk factors, intraoperative parameters, and postoperative morbidity/mortality, with follow-up up to 60 months. Statistical analysis included chi-squared test, Fisher exact test, Kaplan-Meier, and Cox regression.
Main Results:
- Octogenarians had a higher proportion of females, emergent operations, and worse ejection fractions, but lower cholesterol levels and fewer distal anastomoses.
- No significant differences in 30-day or 7-day mortality were observed between groups.
- Octogenarians experienced higher incidences of pulmonary complications, atrial fibrillation, and cognitive disturbances, but Cox regression analysis revealed similar long-term survival rates.
Conclusions:
- The pi-circuit technique for OPCAB is highly effective in octogenarian patients.
- Despite a higher rate of early postoperative morbidity in octogenarians, the overall survival is not adversely affected.
- OPCAB with the pi-circuit procedure offers a viable revascularization strategy for elderly patients with ischemic heart disease.
Background:
Approximately 18% of octogenarians have ischemic heart disease. Increasingly, they are being referred for coronary artery revascularization by surgical and/or percutaneous procedures. These strategies have been questioned, however, because of reports of poor outcomes in the elderly. In this study, we aimed to determine the impact of age on morbidity and mortality in patients undergoing off-pump coronary artery bypass (OPCAB) with the pi-circuit procedure during 5 years of follow-up.
Materials And Methods:
From February 2001 to November 2005, 1359 patients underwent isolated coronary revascularization with the pi-circuit technique, which consists of (1) beating heart surgery, (2) OPCAB, (3) no touching of the aorta, (4) use of composite grafts, and (5) arterial revascularization. Sixty-two patients were > or = 80 years of age (group A), and 1297 were <80 years old (group B). Both groups were compared with respect to preoperative risk factors, intraoperative parameters, and postoperative morbidity and mortality. Follow-up lasted from 4 to 60 months. Data were analyzed with the chi(2) test, the Fisher exact test, the Kaplan-Meier method, and the Cox model of regression analysis.
Results:
Females predominated among the octogenarians (P < .0005). Octogenarians more frequently underwent emergent operations (P < .031) and had worse ejection fractions (P < .026). Obesity was also less prevalent among these patients (P < .007). There were no differences between the groups in the preoperative and postoperative use of an intraaortic balloon pump. Octogenarians had lower cholesterol levels (P < .0005) and had fewer distal anastomoses (2.24 + or - 0.0.76 versus 2.77 + or - 0.92, P < .0005). The 2 groups were not significantly different with respect to 30-day mortality (3.2% versus 1.5%) and 7-day mortality (1.6% versus 0.2%). Differences were noted in the incidences of pulmonary complications (12.9% versus 5.6%, P < .027), atrial fibrillation (41.9% versus 19%, P < .0005), and cognitive disturbances (6.5% versus 0.3%, P < .0005). During follow-up, survival seemed to favor the younger group (P < .001). Nevertheless, further analysis of the data with the Cox regression model to exclude confounding risk factors, revealed the survival rates of the 2 groups to be similar.
Conclusions:
Use of the pi-circuit technique is very effective for octogenarians. Although these older patients have a higher incidence of early postoperative morbidity, overall survival is not affected.
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