Does avoidance of cardiopulmonary bypass confer any benefits in octogenarians undergoing coronary surgery?

Saleh, Hesham Zayed; Shaw, Matthew; Fabri, Brian M.; Chalmers, John

doi:10.1510/icvts.2010.249789

Cited by 23 publications

(37 citation statements)

References 25 publications

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“…For the three RCTs, removal of any one study did not significantly influence the results indicating no individual study overly influenced the findings (Figure 4). In contrast, for the non-RCTs, removal of the study by Sarin et al (15 ) substantially affected the pooled odds (Figure 4). …”

Section: Resultsmentioning

confidence: 93%

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Zhu

Xiong

Ding

et al. 2017

Braz J Med Biol Res

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The aim of this study was to analyze if off-pump coronary artery bypass surgery (CABG) is associated with better treatment outcomes in elderly patients (>70 years of age) than on-pump CABG, using meta-analysis. Medline, PubMed, Cochrane and Google Scholar databases were searched until September 13, 2016. Sensitivity and quality assessment were performed. Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs were included with 24,127 patients. The risk of death associated with on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945, 95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk was lower in patients treated with off-pump CABG than on-pump CABG (pooled OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed between the two treatment groups in terms of the occurrence of 30-day post-operative stroke or myocardial infarction (P≥0.147). In the non-RCTs, off-pump CABG treatment was associated with a shorter length of hospital stay (pooled standardized difference in means=-0.401, 95%CI=-0.621 to -0.181, P≤0.001). The meta-analysis with pooled data from non-RCTs, but not RCTs, found that mortality was lower with off-pump compared with on-pump CABG, and suggested that there may be some benefit of off-pump CABG compared with on-pump CABG in the risk of mortality and length of hospital stay.

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Section: Resultsmentioning

confidence: 93%

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Zhu

Xiong

Ding

et al. 2017

Braz J Med Biol Res

View full text Add to dashboard Cite

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“…Of these, the incidence of AF was observed in 32.2% of the patients, bronchopneumonia in 10.3%, sepsis in 3.4%, AMI in 2.3%, mediastinitis in 1.1%, transient ischemic attacks (TIAs) in 1.1%, and pneumothorax in 1.1%. However, contrary to all these studies, Saleh et al [21] compared retrospectively isolated on-pump and off-pump CABG in 343 octogenarian patients who were matched by the propensity score. They observed no significant differences between on-pump and off-pump patients with regards in-hospital mortality rate, MI, and stroke.…”

Section: Discussionmentioning

confidence: 99%

A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada

Rocha¹,

Pittella²,

Lorenzo³

et al. 2012

Rev Bras Cir Cardiovasc

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A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isoladaAge influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery Abstract Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients ≥ 70 years old in comparison to patients <70 years old.Methods: Patients undergoing isolated CABG were selected for the study. The patients were assigned into two groups: G1 (age ≥ 70 years old) and G2 (age <70 years old).The endpoints were in-hospital mortality, acute myocardial infarction (AMI), stroke, re-exploration for bleeding, intraaortic balloon pump for circulatory shock, respiratory complications, acute renal failure, mediastinitis, sepsis, atrial fibrillation, and complete atrioventricular block (CAVB).Results: A total of 1,033 were included in the study: G1 Rev Bras Cir Cardiovasc 2012;27(1):45-51

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“…Others have attributed the decline to the increasing use of off-pump surgery with an adjusted odds ratio (OR) for operative mortality in the California database of 0.752 (P < 0.001) for off-pump coronary artery bypass (OPCAB) compared with on-pump CABG patients older than 75 years of age [9 & ]. Despite encouraging early reports, results have varied [21,22]. LaPar et al [23] KEY POINTS Morbidity and mortality for CABG surgery in octogenarians is continuing to decrease.…”

Section: Surgical Mortalitymentioning

confidence: 99%

“…The limitations of retrospective data and the importance of subtle difference in surgical technique are clearly evident when one compares these findings with more recent reports. Saleh et al [22] reviewed the results of CABG in 343 octogenarians and used propensity scoring to match 107 each who had on-pump vs. OPCAB. They found there was no difference in mortality or stroke.…”

Section: Surgical Morbiditymentioning

confidence: 99%

Do octogenarians benefit from coronary artery bypass surgery

Kurlansky

2012

Current Opinion in Cardiology

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Although it is clear that CABG surgery in octogenarians can be accomplished with increasingly good results, future research will need to focus on what specific surgical strategies are most appropriate for this elderly cohort; how the collaborative 'Heart Team' approach can be most effectively applied to determination of the most appropriate therapeutic course for these complex, frequently high-risk patients; what strategies can be applied to best manage and possibly reverse patient frailty; and what economic models most meaningfully inform clinical and public policy decision-making.

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Does avoidance of cardiopulmonary bypass confer any benefits in octogenarians undergoing coronary surgery?

Cited by 23 publications

References 25 publications

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

Comparison of outcomes between off-pump versus on-pump coronary artery bypass surgery in elderly patients: a meta-analysis

A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada

Do octogenarians benefit from coronary artery bypass surgery

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