Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?

Damien J. Lapar, Castigliano Bhamidipati, T. Brett Reece, Joseph C. Cleveland, Irving L. Kron, Gorav Ailawadi

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective: Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass. Methods: A total of 1993 elderly patients (age ≥ 80 years) underwent isolated, primary coronary artery bypass graft operations at 16 different statewide centers from 2003 to 2008. Patients were stratified into 2 groups: conven-tional coronary artery bypass (n = 1589, age = 82.5 ± 2.4 years) and off-pump bypass (n = 404, age = 83.0 ± 2.4 years). Preoperative risk, intraoperative findings, postoperative complications, and costs were evaluated. Results: Patients undergoing off-pump bypass grafting were marginally older (P = .001) and had higher rates of preoperative atrial fibrillation (14.6% vs 10.0%; P = .01) and New York Heart Association class IV heart failure (29.7% vs 21.1%; P < .001) than did those having conventional coronary bypass grafting. Other patient risk factors and operative variables, including Society of Thoracic Surgeons predicted risk of mortality, were similar in both groups (P = .15). Compared with off-pump bypass, conventional coronary bypass incurred higher blood transfusion rates (2.0 ± 1.7 units vs 1.6 ± 1.9 units; P = .05) as well as more postoperative atrial fibrillation (28.4% vs 21.5%; P = .003), prolonged ventilation (14.7% vs 11.4%; P = .05), and major complications (20.1% vs 15.6%; P = .04). Importantly, postoperative stroke (2.6% vs 1.7%; P = .21), renal failure (8.1% vs 6.2%; P = .12), and postoperative length of stay (P = .41) were no different between groups. Despite more complications in patients having conventional bypass, operative mortality (P = .53) and hospital costs (P = .43) were similar to those of patients having off-pump procedures. Conclusions: Performance of coronary artery bypass grafting among octogenarian patients is safe and effective. Off-pump coronary artery bypass confers shorter postoperative ventilation but equivalent mortality to conventional coronary artery bypass. Off-pump coronary artery bypass was associated with a reduction in the composite incidence of major complications in unadjusted and adjusted analyses and should be considered an acceptable alternative to conventional bypass for myocardial revascularization in elderly patients.

Original languageEnglish (US)
Pages (from-to)81-90
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume141
Issue number1
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

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Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Atrial Fibrillation
Ventilation
Mortality
Myocardial Revascularization
Hospital Costs
Cardiopulmonary Bypass
Blood Transfusion
Renal Insufficiency
Length of Stay
Heart Failure
Stroke

Keywords

  • CABG
  • cardiopulmonary bypass
  • coronary artery bypass grafting with cardiopulmonary bypass
  • CPB
  • internal thoracic artery
  • ITA
  • New York Heart Association
  • NYHA
  • off-pump coronary artery bypass grafting
  • OPCAB
  • packed red blood cell
  • PRBC
  • predicted risk of mortality
  • PROM
  • Society of Thoracic Surgeons
  • STS
  • VCSQI
  • Virginia Cardiac Surgery Quality Initiative

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians? / Lapar, Damien J.; Bhamidipati, Castigliano; Reece, T. Brett; Cleveland, Joseph C.; Kron, Irving L.; Ailawadi, Gorav.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 141, No. 1, 01.01.2011, p. 81-90.

Research output: Contribution to journalArticle

Lapar, Damien J. ; Bhamidipati, Castigliano ; Reece, T. Brett ; Cleveland, Joseph C. ; Kron, Irving L. ; Ailawadi, Gorav. / Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 141, No. 1. pp. 81-90.
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abstract = "Objective: Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass. Methods: A total of 1993 elderly patients (age ≥ 80 years) underwent isolated, primary coronary artery bypass graft operations at 16 different statewide centers from 2003 to 2008. Patients were stratified into 2 groups: conven-tional coronary artery bypass (n = 1589, age = 82.5 ± 2.4 years) and off-pump bypass (n = 404, age = 83.0 ± 2.4 years). Preoperative risk, intraoperative findings, postoperative complications, and costs were evaluated. Results: Patients undergoing off-pump bypass grafting were marginally older (P = .001) and had higher rates of preoperative atrial fibrillation (14.6{\%} vs 10.0{\%}; P = .01) and New York Heart Association class IV heart failure (29.7{\%} vs 21.1{\%}; P < .001) than did those having conventional coronary bypass grafting. Other patient risk factors and operative variables, including Society of Thoracic Surgeons predicted risk of mortality, were similar in both groups (P = .15). Compared with off-pump bypass, conventional coronary bypass incurred higher blood transfusion rates (2.0 ± 1.7 units vs 1.6 ± 1.9 units; P = .05) as well as more postoperative atrial fibrillation (28.4{\%} vs 21.5{\%}; P = .003), prolonged ventilation (14.7{\%} vs 11.4{\%}; P = .05), and major complications (20.1{\%} vs 15.6{\%}; P = .04). Importantly, postoperative stroke (2.6{\%} vs 1.7{\%}; P = .21), renal failure (8.1{\%} vs 6.2{\%}; P = .12), and postoperative length of stay (P = .41) were no different between groups. Despite more complications in patients having conventional bypass, operative mortality (P = .53) and hospital costs (P = .43) were similar to those of patients having off-pump procedures. Conclusions: Performance of coronary artery bypass grafting among octogenarian patients is safe and effective. Off-pump coronary artery bypass confers shorter postoperative ventilation but equivalent mortality to conventional coronary artery bypass. Off-pump coronary artery bypass was associated with a reduction in the composite incidence of major complications in unadjusted and adjusted analyses and should be considered an acceptable alternative to conventional bypass for myocardial revascularization in elderly patients.",
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T1 - Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?

AU - Lapar, Damien J.

AU - Bhamidipati, Castigliano

AU - Reece, T. Brett

AU - Cleveland, Joseph C.

AU - Kron, Irving L.

AU - Ailawadi, Gorav

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Objective: Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass. Methods: A total of 1993 elderly patients (age ≥ 80 years) underwent isolated, primary coronary artery bypass graft operations at 16 different statewide centers from 2003 to 2008. Patients were stratified into 2 groups: conven-tional coronary artery bypass (n = 1589, age = 82.5 ± 2.4 years) and off-pump bypass (n = 404, age = 83.0 ± 2.4 years). Preoperative risk, intraoperative findings, postoperative complications, and costs were evaluated. Results: Patients undergoing off-pump bypass grafting were marginally older (P = .001) and had higher rates of preoperative atrial fibrillation (14.6% vs 10.0%; P = .01) and New York Heart Association class IV heart failure (29.7% vs 21.1%; P < .001) than did those having conventional coronary bypass grafting. Other patient risk factors and operative variables, including Society of Thoracic Surgeons predicted risk of mortality, were similar in both groups (P = .15). Compared with off-pump bypass, conventional coronary bypass incurred higher blood transfusion rates (2.0 ± 1.7 units vs 1.6 ± 1.9 units; P = .05) as well as more postoperative atrial fibrillation (28.4% vs 21.5%; P = .003), prolonged ventilation (14.7% vs 11.4%; P = .05), and major complications (20.1% vs 15.6%; P = .04). Importantly, postoperative stroke (2.6% vs 1.7%; P = .21), renal failure (8.1% vs 6.2%; P = .12), and postoperative length of stay (P = .41) were no different between groups. Despite more complications in patients having conventional bypass, operative mortality (P = .53) and hospital costs (P = .43) were similar to those of patients having off-pump procedures. Conclusions: Performance of coronary artery bypass grafting among octogenarian patients is safe and effective. Off-pump coronary artery bypass confers shorter postoperative ventilation but equivalent mortality to conventional coronary artery bypass. Off-pump coronary artery bypass was associated with a reduction in the composite incidence of major complications in unadjusted and adjusted analyses and should be considered an acceptable alternative to conventional bypass for myocardial revascularization in elderly patients.

AB - Objective: Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass. Methods: A total of 1993 elderly patients (age ≥ 80 years) underwent isolated, primary coronary artery bypass graft operations at 16 different statewide centers from 2003 to 2008. Patients were stratified into 2 groups: conven-tional coronary artery bypass (n = 1589, age = 82.5 ± 2.4 years) and off-pump bypass (n = 404, age = 83.0 ± 2.4 years). Preoperative risk, intraoperative findings, postoperative complications, and costs were evaluated. Results: Patients undergoing off-pump bypass grafting were marginally older (P = .001) and had higher rates of preoperative atrial fibrillation (14.6% vs 10.0%; P = .01) and New York Heart Association class IV heart failure (29.7% vs 21.1%; P < .001) than did those having conventional coronary bypass grafting. Other patient risk factors and operative variables, including Society of Thoracic Surgeons predicted risk of mortality, were similar in both groups (P = .15). Compared with off-pump bypass, conventional coronary bypass incurred higher blood transfusion rates (2.0 ± 1.7 units vs 1.6 ± 1.9 units; P = .05) as well as more postoperative atrial fibrillation (28.4% vs 21.5%; P = .003), prolonged ventilation (14.7% vs 11.4%; P = .05), and major complications (20.1% vs 15.6%; P = .04). Importantly, postoperative stroke (2.6% vs 1.7%; P = .21), renal failure (8.1% vs 6.2%; P = .12), and postoperative length of stay (P = .41) were no different between groups. Despite more complications in patients having conventional bypass, operative mortality (P = .53) and hospital costs (P = .43) were similar to those of patients having off-pump procedures. Conclusions: Performance of coronary artery bypass grafting among octogenarian patients is safe and effective. Off-pump coronary artery bypass confers shorter postoperative ventilation but equivalent mortality to conventional coronary artery bypass. Off-pump coronary artery bypass was associated with a reduction in the composite incidence of major complications in unadjusted and adjusted analyses and should be considered an acceptable alternative to conventional bypass for myocardial revascularization in elderly patients.

KW - CABG

KW - cardiopulmonary bypass

KW - coronary artery bypass grafting with cardiopulmonary bypass

KW - CPB

KW - internal thoracic artery

KW - ITA

KW - New York Heart Association

KW - NYHA

KW - off-pump coronary artery bypass grafting

KW - OPCAB

KW - packed red blood cell

KW - PRBC

KW - predicted risk of mortality

KW - PROM

KW - Society of Thoracic Surgeons

KW - STS

KW - VCSQI

KW - Virginia Cardiac Surgery Quality Initiative

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