Does avoidance of cardiopulmonary bypass confer any benefits in octogenarians undergoing coronary surgery?
OBJECTIVE
There remain concerns about hospital outcomes in octogenarians being referred for coronary artery bypass grafting (CABG). Avoiding the use of cardiopulmonary bypass (CPB) may be an attractive option to improve early outcomes in this group of patients.


METHODS
Between April 1997 and March 2010, 343 consecutive patients aged 80-89 years received isolated first time CABG. We used logistic regression to develop a propensity score for off-pump group membership and then performed a propensity matched analysis comparing off-pump (n=107) to on-pump (n=107) groups for early mortality and morbidity. All analysis was performed retrospectively.


RESULTS
Preoperative patient characteristics were comparable in both groups, with mean age 82.0 years (80.6-83.7 years) and logistic EuroSCORE 9.9 (6.1-19.5) in the on-pump group compared to 81.6 (80.7-83.2) and 8.5 (5.3-15.7) in the off-pump group (P=0.96, P=0.23, respectively). Postoperatively, in-hospital mortality was 6.5% in the on-pump group compared to 4.7% in the off-pump group (P=0.55). Postoperative complications showed no statistically significant difference between the two groups. However, off-pump was associated with a shorter mechanical ventilation and intensive care unit (ICU) stay and less use of inotropes.


CONCLUSIONS
In our experience, avoiding CPB was not associated with a statistically significant reduction in early mortality, myocardial infarction or stroke rates. It was only associated with a shorter postoperative ventilation and ICU stay and less use of inotropes.
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK. hzayed@hotmail.com
Hesham Zayed
HZ
Saleh
Matthew
M
Shaw
Brian M
BM
Fabri
John A C
JA
Chalmers
D000367:Age Factors; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality; D003422:Critical Care; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D057216:Propensity Score; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
D002316:Cardiotonic Agents