Biological and clinical outcomes in the elderly with left ventricular dysfunction: Are there differences between...

Area of Science:

• Cardiology
• Cardiac Surgery
• Geriatric Medicine

Background:

• Elderly patients with left ventricular (LV) dysfunction represent a high-risk group for coronary artery bypass grafting (CABG).
• Off-pump coronary artery bypass grafting (OPCABG) aims to reduce myocardial injury compared to conventional on-pump CABG (CCABG).
• The impact of LV dysfunction on outcomes after OPCABG versus CCABG in the elderly remains incompletely understood.

Purpose of the Study:

• To compare biological and clinical outcomes between OPCABG and CCABG in elderly patients (age > 75 years) with preoperative left ventricular ejection fraction (LVEF) < 50%.
• To evaluate the incidence of myocardial injury and major adverse cardiac and cerebrovascular events (MACCE) in these patient groups.

Main Methods:

• Retrospective review of 90 patients aged over 75 with LVEF < 50% undergoing isolated CABG between 2000 and 2009.
• Patients were categorized into OPCABG (39 patients) and CCABG (51 patients) groups.
• Comparison of postoperative cardiac enzyme levels (CK, CK-MB, troponin T) and MACCE.

Main Results:

• Overall in-hospital mortality was 2% and similar between groups (p=0.8336).
• Mean troponin T levels were significantly lower at 6, 24, and 48 hours post-operation in the OPCABG group (p=0.0001, p=0.0021, p=0.0070).
• Ten-year overall survival was 77.6%, with no significant difference in MACCE between the groups (p=0.3016).

Conclusions:

• OPCABG demonstrated a lower incidence of postoperative myocardial injury in elderly patients with LV dysfunction.
• Despite reduced myocardial injury, OPCABG did not result in significantly different long-term MACCE compared to CCABG.
• These findings highlight the importance of considering LV dysfunction when evaluating surgical strategies in high-risk elderly cardiac patients.