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Emergency coronary artery bypass surgery in octogenarians with acute coronary syndrome: off and on pump

E E Tekin1, B Aydinli, M A Yesiltas

  • 1Department of Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey. dresraer@yahoo.com.

European Review for Medical and Pharmacological Sciences
|August 22, 2023
PubMed

Insights

Emergency off-pump coronary artery bypass surgery (CABG) is safer for octogenarians with acute coronary syndrome (ACS). This approach reduces complications like stroke and renal failure compared to on-pump surgery.

Area of Science:

  • Cardiac Surgery
  • Cardiology
  • Geriatric Medicine

Background:

  • Cardiac surgery risks increase with age, particularly in octogenarians with comorbidities.
  • Emergency coronary artery bypass surgery (CABG) for acute coronary syndrome (ACS) carries higher mortality and morbidity than elective procedures.
  • Comparing off-pump (OPCAB) versus on-pump (ONCAB) techniques in this high-risk group is crucial.

Purpose of the Study:

  • To compare the outcomes of off-pump coronary bypass (OPCAB) and on-pump coronary bypass surgery (ONCAB).
  • To evaluate the effectiveness of OPCAB versus ONCAB in octogenarians undergoing emergency CABG for ACS.
  • To identify the optimal revascularization strategy for reducing postoperative complications in elderly ACS patients.

Main Methods:

  • Retrospective analysis of 383 octogenarians undergoing isolated emergency CABG due to ACS.
  • Patients were divided into two groups: OPCAB (n=130) and ONCAB (n=253).
  • Preoperative, intraoperative, and postoperative data were collected and compared between the groups.

Main Results:

  • ONCAB patients experienced significantly longer intensive care unit and hospital stays.
  • ONCAB group showed higher rates of erythrocyte suspension transfusion, low cardiac output syndrome, acidosis, acute renal failure, and stroke.
  • OPCAB was associated with fewer major postoperative complications compared to ONCAB.

Conclusions:

  • Emergency OPCAB is a more advantageous revascularization option for elderly patients with ACS.
  • OPCAB significantly reduces the risk of major postoperative complications in this high-risk population.
  • This study supports OPCAB as a preferred strategy for octogenarians with ACS requiring emergency CABG.
Abstract

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