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Heart Lung Circ. 2015 Dec;24(12):1225-32. doi: 10.1016/j.hlc.2015.04.162. Epub 2015 May 14.

Comparison of the Safety and Efficacy of On-Pump (ONCAB) versus Off-Pump (OPCAB) Coronary Artery Bypass Graft Surgery in the Elderly: A Review of the ANZSCTS Database.

Author information

1
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia. Electronic address: vikrantdhurandhar@hotmail.com.
2
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
3
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
4
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
5
Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
6
CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic., Australia.

Abstract

BACKGROUND:

The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. Off-pump coronary artery bypass (OPCAB) may mitigate these outcomes. A retrospective analysis of the results of OPCAB in this population was performed.

METHODS:

We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for elderly patients (n=12697) undergoing isolated CABG surgery and compared the on-pump coronary artery bypass (ONCAB) (n=11676) with OPCAB (n=1021) technique. Preoperative and intraoperative risk factors, and postoperative outcomes were analysed. Survival analyses was performed after cross-matching the database with the national death registry to identify long-term mortality.

RESULTS:

High-risk patients were more prevalent in the ONCAB group (p<0.05). OPCAB patients received fewer distal anastomoses than ONCAB patients (2.4±1.1 vs 3.3±1.0, p<0.001). Thirty-day mortality and stroke rates between OPCAB and ONCAB were not significantly different (2% vs 2.5% and 1.1% vs 1.8%, respectively). There was a non-significant trend towards improved 10-year survival in OPCAB patients using multivariate analysis (78.8% vs. 73.3%, p=0.076, HR 0.83; 95% CI 0.67-1.02).

CONCLUSIONS:

Mortality and stroke rates following CABG surgery are extremely low in the elderly suggesting that surgery is a safe management option for coronary artery disease in this population. OPCAB did not offer a significant advantage over ONCAB with regards to 30-day mortality, stroke and long-term survival. Further prospective randomised trials will be necessary to clarify risks or benefits in the elderly.

KEYWORDS:

Coronary artery bypass graft; Elderly; High risk; Off-pump; On-pump

PMID:
26067551
DOI:
10.1016/j.hlc.2015.04.162
[Indexed for MEDLINE]

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