Off-Pump Coronary Surgery May Reduce Stroke, Respiratory Failure, and Mortality in Octogenarians

摘要

Literature SearchStatistical AnalysisResultsHospital MortalityPostoperative StrokePostoperative Respiratory FailureRenal FailureIntraaortic Balloon Pump SupportPostoperative Atrial FibrillationCommentLimitations of the StudyConclusionsReferencesOctogenarians are a challenging group of patients referred for cardiac surgery. The aim of this study is to assess early outcomes of coronary artery bypass grafting (CABG) performed in the elderly population.MethodsWe performed a meta-analysis of all published observational studies comparing early results of conventional CABG surgery and off-pump CABG surgery in patients aged 80 years or older. The outcomes of interest were mortality, stroke, respiratory failure, renal failure, incidence of support with intraaortic balloon pump, and incidence of postoperative atrial fibrillation. The random effects model was used.ResultsFourteen studies were analyzed. The total number of included subjects was 4,991, of whom 3,113 underwent conventional CABG surgery (62.4%), and 1,878 (37.6%) underwent off-pump CABG surgery. The rates of mortality, stroke, and respiratory failure were significantly higher in the conventional CABG surgery group.ConclusionsThese results confirm that off-pump CABG surgery remains a valuable option of surgical myocardial revascularization, and may optimize the outcome in senior patients.CTSNet classification:23The number of cardiac surgical procedures in patients aged 80 years or older is increasing, as lifetime expectancy is expanding all over the world. Because of multiple comorbidities, but also slower vital and regeneration processes, there is evidence of the increased risk of postoperative complications and mortality in this group. This fact has been reflected in all risk scales predicting the risk of postoperative mortality in cardiac surgery. Thus surgeons are looking for the most effective treatment for elderly patients referred for coronary artery bypass grafting (CABG), bearing in mind the most important issue, that the reduction of risk should be achieved without compromising good long-term outcome.The idea of performing coronary artery revascularization without cardiopulmonary bypass (CPB) was reborn at the end of the 20th century. New technologies and instruments provided the opportunity for the vast majority of cardiac surgeons to learn new beating heart techniques. Nevertheless, today the global percentage of surgeons using less invasive off-pump CABG (OPCAB) procedures is estimated only at 20%, although it is expected that the procedure could be beneficial for high-risk patients [