Off-pump coronary artery bypass surgery (OPCAB) has become a common technique for myocardial revascularization. A number of studies have shown benefits for this technique compared to conventional on-pump bypass surgery, suggesting that older and sicker patients may be able to undergo surgical revascularization with acceptable morbidity. In this study, we analyzed the effectiveness of OPCAB in elderly patients referred for surgical revascularization.
From April 1998 to Oct 2002, 599 patients underwent elective coronary artery bypass using the Octopus 3/Starfish cardiac stabilization system. Among these, 84 patients (14%) were identified who were ≥75 years (Group I). Their postoperative outcomes (obtained from medical records) were compared to those patients ≤74 years (Group II).
The average age was 79.1±3.4 years in Group I and 59.8±9.6 in Group II. Preoperative cardiovascular risk factors including diabetes, smoking, dyslipidemia, and hypertension were similar in both groups. The number of vessels grafted (2.9±0.5 vs 2.8±0.6) were similar in both groups. One patient (1.2%) in Group I needed dialysis (Cr 6.9) compared to 14 (2.7% of 515) in Group II (p=NS). Blood products were transfused in 27% (23/84) of patients in Group I compared with 17% (87/515) in Group II. A significant difference was seen in transient renal failure and mortality. Eighteen percent of patients in Group I developed renal failure, compared with only 5.6% in Group II (p =0.008). Mortality was 2.7% in Group II, but it was 8.3% in Group I, with pulmonary complications being the predominant cause of death.
OPCAB can be used successfully in elderly patients with acceptable results. Co-morbidities such as renal insufficiency and chronic lung disease increase perioperative morbidity and mortality.
The use of OPCAB is safe and reduces mortality and postoperative complications in elderly patients.
P. Vijay, None.