Off-pump surgery decreases postoperative complications and resource utilization in the elderly

doi:10.1016/S0003-4975(99)00951-0

The Annals of Thoracic Surgery

Volume 68, Issue 4, October 1999, Pages 1490-1493

Presented at Evolving Techniques and Technologies in Minimally Invasive Cardiac Surgery Meeting, San Antonio, TX, Jan 22–23, 1999.

https://doi.org/10.1016/S0003-4975(99)00951-0 Get rights and content

Abstract

Background. Bypass surgery in the elderly (age >70 years) has increased mortality and morbidity, which may be a consequence of cardiopulmonary bypass. We compare the outcomes of a cohort of elderly off-pump coronary artery bypass (OPCAB) patients with elderly conventional coronary artery bypass grafting (CABG) patients.

Methods. Chart and provincial cardiac care registry data were reviewed for 30 consecutive elderly OPCAB patients (age 74.7 ± 4.2 years) and 60 consecutive CABG patients (age 74.9 ± 4.1 years, p = 0.82) with similar risk factor profiles: Parsonnet score 17.2 ± 8.1 (OPCAB) versus 15.6 ± 6.5 (CABG), p = 0.31; and Ontario provincial acuity index 4.5 ± 1.9 (OPCAB) versus 4.3 ± 2.0 (CABG), p = 0.65.

Results. Mean hospital stay was 6.3 ± 1.8 days for OPCAB patients and 7.7 ± 3.9 days for CABG patients (p < 0.05). Average intensive care unit stay was 24.0 ± 10.9 h for OPCAB patients versus 36.6 ± 33.5 h for CABG patients (p < 0.05). Atrial fibrillation occurred in 10.0% of OPCAB patients and 28.3% of CABG patients (p < 0.05). Low output syndrome was observed in 10% of OPCAB patients and 31.7% of CABG patients (p < 0.05). Cost was reduced by $1,082 (Canadian) per patient in the OPCAB group. Postoperative OPCAB graft analysis showed 100% patency.

Conclusions. OPCAB is safe in the geriatric population and significantly reduces postoperative morbidity and cost.

Section snippets

Patients and methods

From the inception of a minimally invasive CABG surgery program at the London Health Sciences Centre in November 1996 to June 1998, 120 off-pump operations have been performed at our institution. An analysis of the database identified 30 consecutive patients over 70 years of age in whom myocardial revascularization was achieved via OPCAB. These individuals were compared with 60 consecutive patients over age 70 years who underwent conventional CABG surgery with cardiopulmonary bypass by the same

Operative results

OPCAB patients received fewer grafts than their conventional CABG counterparts (1.7 ± 0.6 vs 2.9 ± 0.9, p < 0.001). The number of arterial conduits was similar between groups (1.0 ± 0.4 vs 0.9 ± 0.5, p = 0.3). No patient in the OPCAB group required conversion to CPB.

In the OPCAB group, 28 of 30 cases were performed through a median sternotomy incision, while the remaining 2 cases were performed through a limited left anterior thoracotomy. Within the OPCAB group, in 1 patient, the left

Comment

The pioneering work of Bennetti and Buffolo and their collaborators demonstrated that it is possible to perform coronary anastomoses on the beating heart 5, 6. While beating heart surgery continues to be explored as an alternative to conventional CABG surgery in many cardiac units worldwide, this revascularization strategy continues to generate controversy. A recurrent criticism of studies evaluating the efficacy of minimally invasive or off-pump cardiac procedures stems from the argument that

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Resting energy expenditure (REE) following cardiac surgery is not determined. We conducted this prospective observational study to clarify this, comparing REE to basal energy expenditure (BEE) estimated using the Harris-Benedict equation (HBE).
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We enrolled 47 patients. Mean age, body weight, and height were 73 ± 10 years (mean ± standard deviation), 55 ± 10 kg, and 155 ± 10 cm, respectively. BEE was 1147 ± 148 kcal/day. The average REE during ventilation was 1314 ± 148 kcal/day (23.9 ± 6.8 kcal/kg/day), significantly higher than estimated BEE (114 ± 35% BEE, p < 0.0001). The average REE was not significantly different between the 2 groups (24 ± 7 vs. 24 ± 6 kcal/kg/day, p = 0.87).
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The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. Off-pump coronary artery bypass (OPCAB) may mitigate these otucomes. A retrospective analysis of the results of OPCAB in this population was performed.
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Supplement: Minimally Invasive Cardiac SurgeryOff-pump surgery decreases postoperative complications and resource utilization in the elderly

Abstract

Section snippets

Patients and methods

Operative results

Comment

Ann Thorac Surg

Chest

Ann Thorac Surg

J Am Coll Cardiol

Supplement: Minimally Invasive Cardiac Surgery
Off-pump surgery decreases postoperative complications and resource utilization in the elderly