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Published on: March 27, 2018
Outcomes after coronary artery bypass in aged patients
José Carlos Rossini Iglézias1, Alex Chi, Aleylove Talans
1Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil. dcirossini@incor.usp.br
Insights
This study compared coronary artery bypass grafting (CABG) outcomes in octogenarians with and without cardiopulmonary bypass. Patients without bypass had lower hospital mortality and stroke rates, but higher late mortality from cardiac causes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Octogenarians represent a growing population undergoing complex cardiac procedures.
- Coronary artery bypass grafting (CABG) is a common intervention for ischemic heart disease.
- The use of cardiopulmonary bypass during CABG in elderly patients warrants careful evaluation.
Purpose of the Study:
- To compare clinical outcomes and survival curves of octogenarians undergoing CABG with versus without cardiopulmonary bypass.
- To identify specific risks and benefits associated with each surgical approach in this age group.
Main Methods:
- Observational cohort study of 396 octogenarians undergoing CABG between 2000-2007.
- Data collected on 36 variables, comparing outcomes between groups (with and without cardiopulmonary bypass).
- Statistical analysis included t-tests, chi-square, and Kaplan-Meier survival curves.
Main Results:
- 290 patients analyzed; 111 without bypass (G1) and 179 with bypass (G2).
- G2 showed significantly higher hospital mortality and stroke rates.
- G1 experienced more postoperative re-admissions for angina, and G2 had higher late mortality, primarily due to cardiac deaths.
Conclusions:
- CABG without cardiopulmonary bypass in octogenarians is associated with lower in-hospital mortality and stroke.
- While patients without bypass had more angina-related re-admissions, those with bypass faced higher long-term cardiac mortality.
Objectives:
Analyze the octogenarians patients submitted to the surgical myocardium revascularization (CABG) with and without extracorporeal comparing the clinical outcomes and its survival curves.
Methods:
Observational study of the cohort type involving 396 octogenarians submitted to the CABG between 01/01/ 2000 and 01/01/2007. Elaboration of an itinerary for collection of data of the handbooks containing 36 variables. Comparison between groups using t test for independent samples, chisquare and survival curves using Kaplan Meier.
Results:
We analyzed 290 patients that possessed appropriate information. The first group G1, of the patients operated without extracorporeal, was constituted of 111 patients and the second group G2, of the operated ones with extracorporeal was constituted of 179 patients. The univariate analyzes had presented statistics significance for the variables: cardiac insufficiency functional class preoperative (P=0.000), tobacco smoking (P=0.050), number of performed grafts (P=0.050), graft type (P=0,000), associates procedures (P=0.000), preoperative use of intra-aortic balloon (P=0.000), hospital mortality (P=0.000) and type of death (P=0.020). In the postoperative outcomes stroke (P=0,036), re-internment for angina (P=0,038). The analyze of the survival curves presented statistic difference (P=0,009).
Conclusions:
Hospital mortality and stroke were bigger in the G2 In the long time the patients of the G1 had respectively presented greater number of re-internments for angina and the late mortality was larger in G2 for the largest prevalence of cardiac deaths.
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