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

Nagpal, A. Dave; Bhatnagar, Gopal; Cutrara, Charles; Ahmed, Sania; McKenzie, Nathalie D.; Quantz, Mackenzie; Kiaii, Bob; Menkis, Alan H.; Fox, Stephanie A.; Stitt, Larry; Novick, Richard J.

doi:10.1016/s0828-282x(06)70303-8

Cited by 36 publications

(42 citation statements)

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“…Moreover, selective use of off-pump CABG (OPCABG) and minimized extracorporeal circulation systems in this high-risk population can reduce multiorgan morbidity and post-operative systemic inflammatory response syndrome. 8,12,[48][49][50][51] However a retrospective analysis of the results of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for elderly patients 52) undergoing isolated CABG surgery compared the on-pump coronary artery bypass (ONCABG) (n = 11676) with OPCABG (n = 1021) technique. The authors showed that high-risk patients were more prevalent in the ONCAB group.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Nicolini

Vezzani²,

Romano

et al. 2017

Int. Heart J.

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SummaryAlthough improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.(Int Heart J 2017; 58: 647-653) Key words: Coronary artery disease, Old patients, Arterial grafts N owadays a growing number of patients are older at the time of coronary artery bypass grafting (CABG) and present with a clinical history characterized by more comorbidities than in the past. However, despite the increasing proportions of elderly patients with a worse risk profile for elective CABG, mortality in elderly patients over recent decades has dramatically declined.1) In fact, recent studies on elderly patients operated with CABG reported a 30-day mortality rate ranging between 3.7 and 16.8%, a 1-year mortality between 8% and 10.8% and a 5-year mortality ranging from 28.4% to 31%. 2-6)It is well recognized that octogenarians have a higher risk of post-operative complications, 7) require greater clinical and economic resources, and have worse but acceptable short and long-term survival in comparison with younger patients. However, improvements in technical management, particularly the development of innovative extracorporeal circulatory systems, the use of off-pump CABG and the increased use of pedicled arterial conduits have been proven effective in improving outcomes, although they have not completely eliminated the morbidity in this high-risk population. [8][9][10][11][12][13][14] Although improved long-term outcomes obtained with the use of ...

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Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Nicolini

Vezzani²,

Romano

et al. 2017

Int. Heart J.

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“…Ji et al [5] reported that diabetic patients aged over 70 years had a higher rate of deep sternal wound infection, while sharing similar rates for other morbidities compared with nondiabetic patients aged over 70 years. Nagpal et al [4], when analyzed octogenarian patients undergoing CABG with or without cardiopulmonary bypass, described that diabetes was not as a risk factor for the occurrence of the combined endpoint of death and major complications.…”

Section: Discussionmentioning

confidence: 99%

“…Patients in this age group tend to have higher rates of comorbidities and risk factors, which may result in more frequent and severe complications, and higher mortality rates [4]. Few studies [5] have investigated the impact of diabetes in the group of older patients, especially octogenarians.…”

Section: Introductionmentioning

confidence: 99%

Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?

Júnior¹,

Pereira²,

Valle³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Introduction: Diabetes is a well known risk factor for early and late adverse outcomes in patients undergoing coronary artery bypass graft surgery (CABG); however, few studies have investigated the impact of this risk factor in the group of older patients, especially octogenarians.Objectives: To compare in-hospital mortality and morbidity of diabetic and nondiabetic patients aged ≥ 80 years submitted to CABG.Methods: A total of 140 consecutive cases were studied, of whom 37 (26.4%) were diabetics, in a retrospective crosssectional study, that included all patients aged ≥ 80 years submitted to isolated/associated CABG. The patients' mean age was 82.5 ± 2.2 years and 55.7% were males.Results: The hospital mortality rate did not significantly differ in multivariate analysis: 16.2% diabetic x 13.6% nondiabetic (P = 0.554), as well as morbidity: 43.2% x 37.9%, respectively (P = 0.533). Regarding to operative morbidity, the occurrence of stroke was significantly higher in diabetic patients in the univariate analysis (10.8% x 1.9%, P = 0.042). In multivariate analysis, however, the incidence of stroke was not associated with the presence of diabetes (P = 0.085), but it was associated with atrial fibrillation (P = 0.044). There was no significant difference related to other complications.Conclusion: In this small consecutive retrospectively analyzed series, there was no significant increase in hospital mortality and morbidity related to diabetes for CABG in octogenarian patients. The impact of the results of this study is limited by the sample size and might be confirmed by future randomized clinical trials.Descriptors: Myocardial revascularization. Aged. Aged, 80 and over. Diabetes mellitus. ResumoIntrodução: O diabetes é um fator de risco conhecido para eventos adversos precoces e tardios em pacientes submetidos à cirurgia de revascularização miocárdica (CRM); entretanto, poucos estudos investigaram sua influência no grupo de pacientes mais idosos, especialmente nos octogenários.Objetivos: Comparar a mortalidade e a morbidade hospitalar de pacientes com idade ≥ 80 anos diabéticos e não-diabéticos submetidos à CRM. 601Rev Bras Cir Cardiovasc 2012;27(4):600-6 Pivatto Júnior F, et al. -Does diabetes mellitus increase immediate surgical risk in octogenarian patients submitted to coronary artery bypass graft surgery?Métodos: Foram estudados 140 casos consecutivos, sendo 37 (26,4%) diabéticos, em um estudo transversal retrospectivo incluindo todos os pacientes com idade ≥ 80 anos submetidos à CRM isolada/associada. A idade média dos pacientes foi de 82,5 ± 2,2 anos e 55,7% eram do sexo masculino.Resultados: A taxa de mortalidade hospitalar não diferiu de maneira significativa na análise multivariada entre os grupos, 16,2% diabéticos x 13,6% não-diabéticos (P=0,554), assim como a morbidade pós-operatória, 43,2 x 37,9%, respectivamente (P=0,533). Em relação à morbidade, a ocorrência de acidente vascular cerebral foi significativamente maior em pacientes diabéticos na análise univariada (10,8% x 1,9%; P = 0,042). Na a...

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“…The benefits of performing off-pump cardiac surgeries in elderly patients have been the subject of debate for some time. A recent article, of which proposal was to analyze the use of off-pump MRS in octogenarian patients in comparison to the conventional surgery, did not demonstrate a significant difference in mortality between these two groups (conventional 6.7%, off-pump 3.1%; p = 0.22) 16 . Li et al 17 , in an analysis of 1,191 patients aged > 65 years, observed that the off-pump MRS was associated with more favorable early outcomes, which, however, did not persist at long-term follow-up, with the traditional surgery being associated with better middle and long-term outcomes.…”

Section: López-rodríguez Et Almentioning

confidence: 97%