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

Does Age at Operation Influence the Short- and Long-Term Outcomes of Off-Pump Coronary Artery Bypass Grafting?

“…In the elderly, respiratory complications are common and contribute to a higher mortality rate after conventional CABG. 20 However, the in-hospital mortality did not increase with aging in this study, possibly because these respiratory complications were not as severe as those observed with conventional CPB, such as pulmonary edema or acute respiratory disorder syndrome, but rather those caused by weakened expectoration of sputum or weakened respiration after general anesthesia. Indeed, Nagpal et al reported favorable results with the shorter postoperative ventilation time in OPCAB patients as compared with those receiving conventional CABG (5.3% and 13.3%, respectively).…”

“…5,6,9,20 A recent metaanalysis of 14 studies of OPCAB in octogenarians demonstrated lower incidences of stroke and respiratory failure in patients receiving OPCAB. 20 The reported in-hospital mortality in the OPCAB group was 3.8% and that in the conventional CABG was 6.0% in patients older than 80 years, and the OR for mortality was 0.54. Saito et al reported the shortterm results in 13,488 cases of isolated CABG with the same age stratification as in the present study.…”

“…23 Stroke occurred in 10 patients (1.3%) postoperatively, being similar to the rates in previous reports on OPCAB. 12,15, 20 Our meticulous pre-and intraoperative risk assessment of cerebrovascular disease and the aorta may have contributed to the absence of differences in the stroke rate among groups. In fact, there was no case of intraoperative stroke in the present study.…”

“…3,5, 20 The relatively high mortality in elderly patients undergoing conventional CABG is considered to result from high rates of perioperative stroke and complications related to CPB. 5,6,9,20 A recent metaanalysis of 14 studies of OPCAB in octogenarians demonstrated lower incidences of stroke and respiratory failure in patients receiving OPCAB.…”

Épidémiologie des accidents vasculaires cérébraux périopératoires

“…Pour les troubles cognitifs é valué s à un an, une mé ta-analyse confirme l'absence de diffé rences entre les deux techniques chirurgicales [63]. De plus, même si plusieurs é tudes plaident pour cette technique chez les patients à risque chirurgical é levé et âgé s de plus de 80 ans [64][65][66][67][68], une nouvelle é tude ne montre pas de diffé rence dans ce dernier groupe pour l'incidence des AVCI et des troubles cognitifs [69]. L'inté rêt des pontages coronaires à coeur battant est donc remis en question.…”