Prapas Sotirios N, Panagiotopoulos Ioannis A, Pentchev Dimitar N, Ayyad Mohamed A Salama, Protogeros Dimitrios A, Kotsis Vasilios N, Linardakis Ioannis N, Tzanavaras Theofanis P, Stratigi Poly T
Department of Cardiac Surgery, Henry Dunant Hospital, Mesoghion 107, Athens GR 11521, Greece.
Heart Surg Forum. 2009 Dec;12(6):E349-53. doi: 10.1532/HSF98.20091125.
Approximately 18% of octogenarians have ischemic heart disease. Increasingly, they are being referred for coronary artery revascularization by surgical and/or percutaneous procedures. These strategies have been questioned, however, because of reports of poor outcomes in the elderly. In this study, we aimed to determine the impact of age on morbidity and mortality in patients undergoing off-pump coronary artery bypass (OPCAB) with the pi-circuit procedure during 5 years of follow-up.
From February 2001 to November 2005, 1359 patients underwent isolated coronary revascularization with the pi-circuit technique, which consists of (1) beating heart surgery, (2) OPCAB, (3) no touching of the aorta, (4) use of composite grafts, and (5) arterial revascularization. Sixty-two patients were > or = 80 years of age (group A), and 1297 were <80 years old (group B). Both groups were compared with respect to preoperative risk factors, intraoperative parameters, and postoperative morbidity and mortality. Follow-up lasted from 4 to 60 months. Data were analyzed with the chi(2) test, the Fisher exact test, the Kaplan-Meier method, and the Cox model of regression analysis.
Females predominated among the octogenarians (P < .0005). Octogenarians more frequently underwent emergent operations (P < .031) and had worse ejection fractions (P < .026). Obesity was also less prevalent among these patients (P < .007). There were no differences between the groups in the preoperative and postoperative use of an intraaortic balloon pump. Octogenarians had lower cholesterol levels (P < .0005) and had fewer distal anastomoses (2.24 + or - 0.0.76 versus 2.77 + or - 0.92, P < .0005). The 2 groups were not significantly different with respect to 30-day mortality (3.2% versus 1.5%) and 7-day mortality (1.6% versus 0.2%). Differences were noted in the incidences of pulmonary complications (12.9% versus 5.6%, P < .027), atrial fibrillation (41.9% versus 19%, P < .0005), and cognitive disturbances (6.5% versus 0.3%, P < .0005). During follow-up, survival seemed to favor the younger group (P < .001). Nevertheless, further analysis of the data with the Cox regression model to exclude confounding risk factors, revealed the survival rates of the 2 groups to be similar.
Use of the pi-circuit technique is very effective for octogenarians. Although these older patients have a higher incidence of early postoperative morbidity, overall survival is not affected.
约18%的八旬老人患有缺血性心脏病。越来越多的此类患者被转诊接受外科和/或经皮冠状动脉血运重建术。然而，由于有报道称老年患者手术效果不佳，这些治疗策略受到了质疑。在本研究中，我们旨在确定年龄对接受采用π形回路技术的非体外循环冠状动脉搭桥术（OPCAB）患者在5年随访期内发病率和死亡率的影响。
从2001年2月至2005年11月，1359例患者采用π形回路技术接受单纯冠状动脉血运重建术，该技术包括：（1）心脏不停跳手术；（2）非体外循环冠状动脉搭桥术；（3）不触碰主动脉；（4）使用复合移植物；（5）动脉血运重建。62例患者年龄≥80岁（A组），1297例患者年龄<80岁（B组）。比较两组患者的术前危险因素、术中参数以及术后发病率和死亡率。随访时间为4至60个月。采用卡方检验、Fisher精确检验、Kaplan-Meier法以及Cox回归分析模型对数据进行分析。
八旬老人中女性居多（P<.0005）。八旬老人急诊手术更为频繁（P<.031），射血分数更差（P<.026）。这些患者肥胖症的患病率也较低（P<.007）。两组患者术前和术后主动脉内球囊泵的使用情况无差异。八旬老人胆固醇水平较低（P<.0005），远端吻合口较少（2.24±0.76对2.77±0.92，P<.
