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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Impact of age on early outcome after coronary bypass graft surgery using minimized versus conventional extracorporeal
Insights
Minimally extracorporeal circulation (MECC) showed better early outcomes in coronary artery bypass graft surgery (CABG) compared to conventional extracorporeal circulation (CECC), regardless of patient age. MECC reduced mortality and complications, highlighting its safety and efficacy in CABG procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Technology
Background:
- Coronary artery bypass graft surgery (CABG) outcomes are influenced by extracorporeal circulation methods.
- Minimally extracorporeal circulation (MECC) and conventional extracorporeal circulation (CECC) represent different approaches to cardiopulmonary support during CABG.
- Evaluating the impact of age on comparative early outcomes between MECC and CECC is crucial for patient stratification and treatment optimization.
Purpose of the Study:
- To compare the early outcomes of CABG using MECC versus CECC, with a specific focus on the influence of patient age.
- To identify independent risk factors for 30-day mortality following CABG in the context of MECC and CECC.
Main Methods:
- A retrospective, age-, gender-, and operation-matched cohort analysis of 2274 patients undergoing CABG between 2005 and 2010.
- Patients were stratified into four age groups: <59, 60-69, 70-79, and ≥80 years.
- Primary endpoint was 30-day mortality; secondary endpoints included renal replacement therapy, respiratory insufficiency, and low cardiac output syndrome.
Main Results:
- Overall 30-day mortality was significantly lower with MECC (2.2%) compared to CECC (4.4%).
- MECC patients experienced significantly lower rates of renal replacement therapy, respiratory insufficiency, and low cardiac output syndrome.
- While age was an independent risk factor for mortality, CECC itself was not, though specific adverse events were higher in the CECC group.
Conclusions:
- MECC is associated with significantly better early outcomes, including lower mortality, compared to CECC in CABG patients, irrespective of age.
- Independent risk factors for 30-day mortality included advanced age, prior myocardial infarction, reduced estimated GFR, and not utilizing the left internal mammary artery.
- The findings support the use of MECC for improved patient safety and outcomes in CABG surgery.
Background:
Objective of this study was to evaluate the impact of age on comparative early outcomes after coronary artery bypass graft surgery (CABG) with minimized (MECC) and conventional extracorporeal circulation (CECC).
Methods:
A retrospective age-, gender- and operation-matched cohort analysis between January 2005 and December 2010 with a total of 2274 patients undergoing CABG with MECC (n = 1137; 50%) or CECC was performed. Patients were stratified into 4 groups according to age: <59 years, 60-69 years, 70-79 years, and 80 years of age or older. Outcomes were compared within each age group. Patients with preoperative dialysis were excluded from analysis. Primary endpoint was 30-day mortality.
Results:
Patients treated with CECC had a significantly higher mean logistic EuroSCORE (6.3% vs. 5.0%; p < 0.001), a slightly lower rate of preoperative myocardial infarction (46% vs. 51%; p = 0.01) and a higher rate of impaired renal function (eGFR < 60 mL/min/1.73 m2: 24% vs. 20%; p = 0.01) compared to MECC-patients. Left internal mammary artery was significantly used more often in MECC patients (93% vs. 86%; p < 0.001). Cardiopulmonary bypass and aortic-cross clamping time were significantly lower in the MECC group (p < 0.001). Overall 30-day mortality was significantly higher in patients treated with CECC (4.4% vs. 2.2%; p = 0.002). Within the different age groups mortality rates were not significantly different except for patients aged 60-69 years (4.5% vs. 1.8%; p = 0.03). Postoperative requirement of renal replacement therapy (4% vs. 2.2%; p = 0.01), respiratory insufficiency (9.9% vs. 6.6%; P = 0.004) and incidence of low cardiac output syndrome (3% vs. 1.2%; p = 0.003) were significantly increased in patients with CECC. Multivariate analysis identified age (p = 0.005; 95% CI 1.01 to 1.08; OR 1.05) among other parameters as an independent risk factor, whereas conventional extracorporeal circulation itself did not present as an independent risk factor for 30-day mortality.
Conclusions:
In this matched study sample early outcome was significantly better in patients with MECC compared to CECC, irrespective of age. Prior myocardial infarction estimated GFR < 60 mL and waiving the use of LIMA were independent risk factors for 30-day mortality, which were more present in the CECC group.
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