Alejandro Suarez-Pierre1, Todd C Crawford2, Charles D Fraser2, Xun Zhou2, Cecillia Lui2, Bradley Taylor3, Kurt Wehberg4, John V Conte5, Glenn J Whitman2, Rawn Salenger6. 1. Division of Cardiac Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Blalock Bldg. 1206, Baltimore, MD, 21287, USA. asuarez8@jhmi.edu. 2. Division of Cardiac Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Blalock Bldg. 1206, Baltimore, MD, 21287, USA. 3. Division of Cardiac Surgery, University of Maryland Heart Center, Baltimore, MD, USA. 4. Division of Cardiac Surgery, Peninsula Regional Medical Center, Salisbury, MD, USA. 5. Division of Cardiac Surgery, Penn State College of Medicine, Hershey, PA, USA. 6. Division of Cardiac Surgery, University of Maryland St. Joseph Medical Center, Baltimore, MD, USA.
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.
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.
Entities:
Keywords:
Coronary artery bypass; Octogenarians; Off pump; Propensity matching
Authors: K P Alexander; K J Anstrom; L H Muhlbaier; R D Grosswald; P K Smith; R H Jones; E D Peterson Journal: J Am Coll Cardiol Date: 2000-03-01 Impact factor: 24.094
Authors: Benjamin D Kozower; Marc R Moon; Hendrick B Barner; Nader Moazami; Jennifer S Lawton; Michael K Pasque; Ralph J Damiano Journal: Ann Thorac Surg Date: 2005-07 Impact factor: 4.330
Authors: M Tofukuji; G L Stahl; C Metais; M Tomita; A Agah; C Bianchi; M P Fink; F W Sellke Journal: Ann Thorac Surg Date: 2000-03 Impact factor: 4.330
Authors: J D Puskas; W H Williams; P G Duke; J R Staples; K E Glas; J J Marshall; M Leimbach; P Huber; S Garas; B H Sammons; S A McCall; R J Petersen; D E Bailey; H Chu; E M Mahoney; W S Weintraub; R A Guyton Journal: J Thorac Cardiovasc Surg Date: 2003-04 Impact factor: 5.209
Authors: Li Zhang; Steven W Boyce; Peter C Hill; Xiumei Sun; Ann Lee; Elizabeth Haile; Jorge M Garcia; Paul J Corso Journal: Cardiovasc Revasc Med Date: 2009 Jan-Mar
Authors: John D Puskas; Patrick D Kilgo; Michael Kutner; Sorin V Pusca; Omar Lattouf; Robert A Guyton Journal: Circulation Date: 2007-09-11 Impact factor: 29.690