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19.10.2018 | Original Article

Off-pump coronary artery bypass in octogenarians: results of a statewide, matched comparison

Zeitschrift:
General Thoracic and Cardiovascular Surgery
Autoren:
Alejandro Suarez-Pierre, Todd C. Crawford, Charles D. Fraser III, Xun Zhou, Cecillia Lui, Bradley Taylor, Kurt Wehberg, John V. Conte, Glenn J. Whitman, Rawn Salenger, on behalf of the MCSQI Collaborative
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11748-018-1025-8) contains supplementary material, which is available to authorized users.

Abstract

Objectives

Off-pump coronary artery bypass grafting (OPCAB) may have advantages in the elderly. Although proven safe, it remains unclear whether OPCAB provides a short-term survival benefit in octogenarians. We sought to compare outcomes using propensity matching between OPCAB and conventional surgery in a statewide database.

Methods

We identified all octogenarians (≥ 80 years) who underwent isolated coronary artery bypass grafting (CAB) at 10 different centers in the state of Maryland from July 2011 to June 2016. We separated patients into two groups: OPCAB and on-pump coronary artery bypass (ONCAB). Patients were assigned propensity scores with a semi-parsimonious logistic regression model and matched 1:1 by the nearest-neighbor principle. A revascularization ratio was determined between the number of distal grafts sewn and number of diseased coronaries (≥ 50% stenosis).

Results

In total, 926 octogenarians underwent isolated CAB (8.2% of all CAB): 798 (86%) had ONCAB and 128 (14%) had OPCAB. Propensity matching yielded 128 well-matched pairs. Operative mortality was similar between groups (OPCAB 5.5% vs ONCAB 3.1%, p = 0.364). Rates of complications were similar between groups. OPCAB patients had a lower revascularization ratio (0.92 vs 1.15, p < 0.001), but more frequent use of left internal mammary artery (97 vs 89%, p = 0.017), and decreased intraoperative transfusion rates (33 vs 63%, p < 0.001).

Conclusions

In comparing outcomes among octogenarians across the state of Maryland, OPCAB and ONCAB had similar mortality and morbidity. However, OPCAB was associated with a lower revascularization ratio. Thus, our results demonstrate no short-term survival benefit of OPCAB over ONCAB in octogenarians.

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Zusatzmaterial
Supplementary material 1 (DOCX 16 KB)
11748_2018_1025_MOESM1_ESM.docx
Literatur
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