[Performing off-pump coronary artery bypass grafting in elderly patients safely].
The elderly patients of the ischemic heart disease have been increasing in recent years. From January 2001 to December 2004, 41 patients were aged 80 years or older underwent off-pump coronary artery bypass grafting (OPCAB) in our hospital. To perform OPCAB of elderly patient safely, we review presence of carotid artery stenosis and previous cerebral infarction preoperatively and use high thoracic epidural anesthesia (TEA) and coronary artery active perfusion system (CAPS) intraoperatively. TEA provides bradycardia and coronary vasodilatation which facilitate beating-heart surgery technically, and prevent intra- and postoperative arrhythmia. Comparing with before use of TEA, operating time and postoperative intubation time decreased significantly. Using CAPS anastomosis was performed under bloodless field and stable hemodynamics. There was no operative death and severe postoperative complication. In conclusion, with careful preoperative inspection and using TEA and CAPS, OPCAB can be performed safely in octogenarians.
Tomita
S
S
Department of General and Cardiothoracic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Watanabe
G
G
D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D002544:Cerebral Infarction / Q000517:prevention & control; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D017202:Myocardial Ischemia / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies
D006493:Heparin