Off-pump versus on-pump coronary artery bypass surgery in patients aged 80 years and older: institutional results and meta-analysis

Abstract

Patients aged ≥80 years are at high risk of adverse events after coronary artery bypass grafting. This study was performed to evaluate whether off-pump coronary artery bypass surgery (OPCAB) is superior to conventional surgery (CCAB) in these high-risk patients. The outcome of 185 patients aged ≥80 years who underwent OPCAB or CCAB at our institution was reviewed and a meta-analysis on this issue was performed. Similar immediate postoperative results were observed after OPCAB and CCAB at our institution, despite significantly different operative risk (mean logistic EuroSCORE, OPCAB 20.3% vs CCAB 13.4%, P = 0.003). Among 56 propensity score matched pairs a trend toward lower postoperative stroke (0%, 95% CI 0-0 vs 3.6%, 95% CI 0-10.0, P = 0.50) was observed after OPCAB. No significant differences were observed in the other outcome end points. Five-year survival was 81.0% after OPCAB and 78.1% after CCAB (P = 0.239). Pooled analysis of eight studies including 3416 patients showed a significantly higher risk of postoperative stroke after CCAB (pooled rates: 4.2%, 95% confidence interval (95% CI) 2.4-7.1 vs 1.5%, 95% CI 0.9-2.5, risk ratio (RR) 2.15, 95% CI 1.17-3.96, P = 0.01). A trend toward higher immediate postoperative mortality was observed after CCAB (15 studies including 4409 patients, pooled rates: 6.5%, 95% CI 5.2-8.0 vs 5.6%, 95% CI 4.2-7.4, RR 1.29, 95% CI 0.86-1.93, P = 0.21). Generic inverse variance analysis showed similar intermediate survival after CCAB and OPCAB (RR 1.31, 95% CI 0.85-2.01, P = 0.22). At 2 years, survival was 82.8% (95% CI 76.4-89.2) after CCAB and 88.3% (95% CI 82.9-93.7) after OPCAB. Current results indicate that OPCAB compared with CCAB in patients aged ≥80 years is associated with significantly lower postoperative stroke and with a trend toward better early survival. However, suboptimal quality of the available studies, particularly the lack of comparability of the study groups, prevents conclusive results on this controversial issue.

Off-pump versus on-pump coronary artery bypass grafting surgery in high-risk patients: PRAGUE-6 trial at 30 days and 1 year

“…Similar outcomes were also observed in elderly high-risk patients. A trend toward lower incidence of post-operative stroke among octogenarians in the offpump group was also present 19 . Somewhat surprisingly, we had better results than Houlind et al in the DOORS study, (4.0% vs. 2.2%, strokes during first 30 days) (ref.…”

Off-pump coronary artery bypass grafting in octogenarians

“…All 18 studies were retrospective studies (2,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Five studies (38,40,(42)(43)(44) presented propensity-matched comparison of the 2 cohorts. One presented the analysis of the Nationwide Inpatient Sample database from 2005 to 2010 (39), whereas another reported data from the State of Virginia database for the period 2003 to 2008 (44).…”

One-year results of coronary artery stenting in elderly patients

“…По данным мета-анализа восьми исследований у больных 80 лет и старше выживание составило 82,8% (95% ДИ 76,4-89,2) при КШ в условиях ИК и 88,3% (95% ДИ 82,9-93,7) после операций на работающем сердце. Однако сами автора анализа отмечают, что субоптимальная сопоставимость исследованных групп не позволяет сделать окончательных выводов в этом противоречи-вом вопросе [16]. В нашей работе также не отмечено влияния выполнения КШ в условиях ИК или на рабо-тающем сердце на годовой прогноз пациентов.…”