Demers P, Cartier R
Department of Surgery, Montreal Heart Institute, Research Center, 5000 Bélanger Street East, Montreal, Quebec, H1T 1C8, Canada.
Eur J Cardiothorac Surg. 2001 Nov;20(5):908-12. doi: 10.1016/s1010-7940(01)00973-3.
Coronary artery bypass grafting in the elderly patient is associated with increased perioperative morbidity and mortality. The avoidance of cardiopulmonary bypass (CPB) in this population is potentially beneficial. We examined our initial experience with off-pump multivessel coronary artery revascularization in patients aged 70 years and older.
In a consecutive series of 300 off-pump coronary artery bypass (OPCAB) operations performed by a single surgeon between 1996 and 1999, 98 patients were aged 70 years and older. These patients were compared with a consecutive cohort of 497 patients aged 70 years and older operated on with CPB in the same institution from 1995 to 1996, period where OPCAB surgery was not performed in our institution.
Patients in the beating heart group were older (75+/-4 vs. 74+/-3 years; P=0.001). Gender distribution and other preoperative risk factors were comparable for the two groups. On average, 3.0+/-0.8 and 2.8+/-0.7 grafts per patient were completed in the OPCAB and the CPB groups, respectively (P=0.007). Perioperative mortality rates (OPCAB group, 3.1%; CPB group, 3.6%), perioperative myocardial infarction (OPCAB, 2.0%; CPB, 5.1%) and neurologic events (OPCAB, 1.0%; CPB, 3.2%) were comparable for the two groups. The incidence of postoperative atrial fibrillation was lower in the OPCAB group (42 vs. 54%; P=0.05). The need for allogenic blood transfusions was significantly less in the OPCAB group (53 vs. 82%; P=0.001).
In patients aged 70 years and older, multivessel OPCAB surgery is associated with lower rates of postoperative atrial fibrillation and reduced transfusion requirements. Multivessel OPCAB in the elderly patient is an acceptable alternative to procedures performed with CPB.
老年患者冠状动脉搭桥术与围手术期发病率和死亡率增加相关。在此人群中避免使用体外循环（CPB）可能有益。我们研究了70岁及以上患者非体外循环多支冠状动脉血运重建的初步经验。
在1996年至1999年间由一名外科医生连续进行的300例非体外循环冠状动脉搭桥（OPCAB）手术中，98例患者年龄在70岁及以上。将这些患者与1995年至1996年在同一机构接受CPB手术的497例70岁及以上的连续队列患者进行比较，此期间我们机构未进行OPCAB手术。
心脏跳动组患者年龄更大（75±4岁对74±3岁；P = 0.001）。两组的性别分布和其他术前危险因素具有可比性。OPCAB组和CPB组患者平均分别完成3.0±0.8支和2.8±0.7支移植血管（P = 0.007）。两组的围手术期死亡率（OPCAB组3.1%；CPB组3.6%）、围手术期心肌梗死（OPCAB组2.0%；CPB组5.1%）和神经系统事件（OPCAB组1.0%；CPB组3.2%）具有可比性。OPCAB组术后房颤发生率较低（42%对54%；P = 0.05）。OPCAB组异体输血需求显著更少（53%对82%；P = 0.001）。
在70岁及以上患者中，多支血管OPCAB手术与较低的术后房颤发生率和减少的输血需求相关。老年患者多支血管OPCAB是CPB手术的可接受替代方案。
