TY - JOUR
T1 - Comparison of the safety and efficacy of on-pump (ONCAB) versus off-pump (OPCAB) coronary artery bypass graft surgery in the elderly
T2 - a review of the ANZSCTS database
AU - Dhurandhar, Vikrant
AU - Saxena, Akshat
AU - Parikh, Roneil
AU - Vallely, Michael P.
AU - Wilson, Michael K.
AU - Butcher, Jennifer Kay
AU - Black, Deborah Ann
AU - Tran, Lavinia
AU - Reid, Christopher M.
AU - Bannon, Paul G.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background: The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. Off-pump coronary artery bypass (OPCAB) may mitigate these otucomes. 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.
AB - Background: The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. Off-pump coronary artery bypass (OPCAB) may mitigate these otucomes. 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.
KW - coronary artery bypass graft
KW - elderly
KW - high risk
KW - off-pump
KW - on-pump
UR - http://www.scopus.com/inward/record.url?scp=84947487189&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2015.04.162
DO - 10.1016/j.hlc.2015.04.162
M3 - Article
C2 - 26067551
AN - SCOPUS:84947487189
VL - 24
SP - 1225
EP - 1232
JO - Heart, Lung and Circulation
JF - Heart, Lung and Circulation
SN - 1443-9506
IS - 12
ER -