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Published on: March 27, 2018
Propensity score analysis comparing off-pump versus on-pump coronary artery bypass grafting in older adults
Shinji Ogawa1, Yoshiharu Mori2, Tumurbaatar Batkhishig2
1Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 467-8601, Japan. ogashin555@gmail.com.
Insights
Off-pump coronary artery bypass grafting shows better outcomes in older adults compared to on-pump procedures. Off-pump surgery reduces transfusion needs, atrial fibrillation, and improves long-term survival for elderly patients.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Cardiac Surgery Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Older adults (≥75 years) present unique challenges and risks for CABG.
- Comparing on-pump versus off-pump CABG in this demographic is crucial for optimizing patient care.
Purpose of the Study:
- To compare the early and late outcomes of off-pump coronary artery bypass grafting (OPCAB) versus on-pump CABG in patients aged 75 years and older.
- To evaluate the impact of surgical technique on survival and major adverse cardiac events in the elderly population.
Main Methods:
- A retrospective study included 226 patients (≥75 years) undergoing isolated CABG.
- Patients were divided into off-pump (n=141) and on-pump (n=85) groups.
- Propensity score matching was used to compare outcomes in 68 matched pairs, focusing on mid-term survival and major adverse cardiac events.
Main Results:
- On-pump CABG was associated with significantly longer operative times, higher red blood cell transfusion volumes, and extended hospital stays.
- The incidence of new-onset atrial fibrillation was substantially higher in the on-pump group (27.9% vs 4.4%).
- Kaplan-Meier analysis revealed significantly worse 3-year survival rates for the on-pump group (71.5%) compared to the off-pump group (90.7%), though cardiovascular-related deaths did not differ significantly.
Conclusions:
- On-pump CABG in older adults leads to increased complications, including higher transfusion requirements and postoperative atrial fibrillation.
- Mid-term outcomes, particularly overall survival, are poorer with on-pump CABG in this age group.
- Off-pump CABG demonstrates a survival benefit, reducing all-cause mortality in elderly patients undergoing coronary artery bypass grafting.
Objective:
This study aimed to compare the results of off-pump and on-pump coronary artery bypass grafting in older adults and to examine early and late outcomes.
Methods:
This study included 226 patients aged ≥ 75 years who underwent isolated coronary artery bypass grafting. Of these, 141 and 85 patients were included in the off-pump and on-pump groups, respectively. Propensity scores were calculated for each case, matched, and compared between the two groups (68 cases in each group), along with mid-term outcomes of survival and major adverse cardiac events.
Results:
Operative time, red blood cell transfusion volume, and postoperative hospital stay duration were significantly higher in the on-pump group (267 vs 370 min, P < 0.001; 4.3 vs 17.2 units, P < 0.001; and 20.8 vs 35.8 days, P = 0.012, respectively). Postoperative occurrence of new atrial fibrillation was significantly higher in the on-pump group (4.4% vs 27.9%, P < 0.001), and Kaplan-Meier survival analysis showed a significantly worse prognosis in the on-pump group than in the off-pump group (3-year survival rate 90.7% vs 71.5%, log rank P = 0.007). However, there was no statistically significant difference in cardiovascular-related deaths (log rank P = 0.07).
Conclusions:
On-pump coronary artery bypass grafting in an older adult population resulted in increased transfusion volume and postoperative occurrence of atrial fibrillation. The mid-term postoperative outcomes were also poorer with on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting reduced future all-cause deaths in older adults.
