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Published on: March 27, 2018
Coronary artery bypass grafting in octogenarians: long-term results
Marco Serrão1, Francisco Graça, Rui Rodrigues
1Serviço de Cirurgia Cardiotorácica, Hospital de Santa Cruz, Lisboa, Portugal. serrao.marco@gmail.com
Insights
Coronary artery bypass grafting in octogenarians yields excellent outcomes. Off-pump surgery offers shorter hospital stays with comparable long-term results to on-pump procedures, despite potentially less complete revascularization.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Surgical Outcomes Research
Background:
- Surgical revascularization is increasingly performed in octogenarian patients.
- Evaluating the impact of coronary artery bypass grafting (CABG) on morbidity and mortality in this age group is crucial.
Purpose of the Study:
- To analyze the short- and long-term outcomes of CABG in patients aged 80 years and older.
- To compare the results of off-pump versus on-pump CABG in octogenarians.
Main Methods:
- Retrospective study of 101 consecutive patients (≥80 years) undergoing CABG between 2002-2007.
- Patients divided into off-pump (64.4%) and on-pump (35.6%) groups.
- Assessment of early and up to 6-year post-operative results.
Main Results:
- No significant differences in age or logistic EuroSCORE between off-pump and on-pump groups.
- Off-pump group had less complete revascularization (43.1% vs. 83.3%) but shorter hospital stay (9.3 vs. 11.5 days).
- Low hospital mortality in both groups (1.5% off-pump vs. 2.8% on-pump) and similar 6-year survival rates (80% vs. 77.4%).
Conclusions:
- Coronary artery bypass grafting demonstrates excellent results in octogenarian patients.
- Off-pump CABG in octogenarians leads to shorter hospital stays.
- Off-pump CABG achieves comparable 6-year survival and cardiovascular mortality rates to on-pump procedures in this elderly population.
Introduction:
As surgical revascularization is becoming more frequent in octogenarians, we reviewed our data to analyze the impact of coronary artery bypass grafting on short- and long-term morbidity and mortality.
Methods:
We performed a retrospective study of 101 consecutive patients aged 80 years or older, who underwent coronary artery bypass in a single cardiac center between January 2002 and December 2007. The patients were divided into two groups: off-pump (64.4%) and on-pump (35.6%), depending on whether the surgery was performed with cardiopulmonary bypass. Early results and those up to 6 years after surgery were assessed.
Results:
Baseline characteristics were similar between the groups and follow-up was 90% complete. There were no significant differences between groups in mean age (off-pump = 82.7 +/- 18 years vs. on-pump = 82.2 +/- 2.2 years; p = NS) or in logistic EuroSCORE (off-pump = 11.2 +/- 12.3 vs. on-pump = 8.5 +/- 5.1; p = NS). However, the off-pump group had less complete revascularization (off-pump = 43.1% vs. on-pump = 83.3%, p = 0.0001) and shorter mean hospital stay (off-pump = 9.3 +/- 5.4 days vs. on-pump = 11.5 +/- 7.3 days; p = 0.09). Both groups showed low hospital mortality (off-pump = 1.5% vs. on-pump = 2.8%, p = NS). At 6-year follow-up, off-pump surgery patients had the same late prognosis (total survival: off-pump = 80% vs. on-pump = 77.4%, p = NS; cardiovascular mortality: off-pump = 15% vs. on-pump = 16.1%, p = NS).
Conclusion:
In octogenarians coronary artery bypass grafting had excellent results. The off-pump technique, even though it can mean less complete revascularization, leads to shorter hospital stay and has the same 6-year results as in patients operated under cardiopulmonary bypass.
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