Early outcomes of coronary artery bypass with and without cardiopulmonary bypass in octogenarians

A. D. Nagpal, G. Bhatnagar, C. A. Cutrara, S. M. Ahmed, N. McKenzie, M. Quantz, B. Kiaii, A. Menkis, S. Fox, L. Stitt, R. J. Novick

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Off-pump coronary artery bypass (OPCAB) surgery has been successfully used in diverse patient populations and has been postulated to be safer than conventional coronary artery bypass (CCAB) surgery in some high-risk patients, including the elderly. Objective: To compare the safety of OPCAB surgery versus CCAB surgery in the octogenarian population of two large southwestern Ontario cardiac surgical units. Results: Two hundred thirty-six consecutive octogenarians underwent primary isolated coronary artery bypass sugery from November 2000 to March 2005. Patients undergoing OPCAB surgery tended to have higher Parsonnet scores, while patients undergoing CCAB surgery had a greater number of emergent operations. The Canadian Cardiovascular Network predicted that mortality risk was similar in both groups. In-hospital mortality was similar between groups, as was postoperative myocardial infarction and new onset of renal dysfunction. However, in the OPCAB group, there was a decreased incidence of postoperative neurological dysfunction (2.3% in the OPCAB group versus 10.5% in the CCAB group, P=0.01), in particular cerebrovascular accidents (1.5% in the OPCAB group versus 7.6% in the CCAB group, P=0.05), and a decreased incidence of prolonged intubation (5.3% in the OPCAB group versus 13.3% in the CCAB group, P=0.04). Multivariable analysis found that cardiopulmonary bypass had no significant impact on mortality or length of stay. Conclusions: In octogenarian patients, OPCAB surgery is as safe as CCAB surgery in terms of mortality and major morbidity. Furthermore, a significant reduction in neurological dysfunction and prolonged intubation was seen in the OPCAB group compared with the CCAB group.

Original languageEnglish (US)
Pages (from-to)849-853
Number of pages5
JournalCanadian Journal of Cardiology
Volume22
Issue number10
DOIs
StatePublished - Aug 2006
Externally publishedYes

Keywords

  • Cardiopulmonary bypass
  • Cerebrovascular accident
  • Coronary artery bypass surgery
  • Octogenarian
  • Off-pump
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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