Altarabsheh Salah E, Deo Salil V, Rababa'h Abeer M, Lim Ju Yong, Cho Yang Hyun, Sharma Vikas, Jung Sung Ho, Shin Euisoo, Markowitz Alan H, Park Soon J
Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan.
Department of Cardiovascular Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
Ann Thorac Surg. 2015 May;99(5):1568-75. doi: 10.1016/j.athoracsur.2014.12.057. Epub 2015 Mar 17.
Data comparing results of off-pump and conventional operations in octogenarians is very limited. Thus we chose to compare early adverse events between off-pump coronary artery bypass grafting (OPCABG) and on-pump CABG (ONCABG) in patients older than 80 years.
Systematic review of multiple databases was performed to obtain original studies fulfilling search criteria. End points--early mortality, stroke, respiratory failure, atrial fibrillation, and myocardial infarction--were compared between these cohorts. A random-effects weighted analysis was performed using the trim-fill adjustment when necessary. Results are presented as risk ratios (RRs) with 95% confidence intervals (CIs); p < 0.05 is considered statistically significant.
Sixteen retrospective studies (9,744 ONCABG and 8,566 OPCABG patients) were included in the systematic review. OPCAGB patients received significantly fewer grafts (2.54 ± 0.16) compared with ONCABG patients (3.22 ± 0.41). Early mortality was comparable at 4.6% and 5.2% in the OPCABG and ONCABG cohorts, respectively (risk ratio [RR], 0.91; 95% CI, 0.64-1.28; p = 0.598). Stroke rates were higher in the ONCABG cohort (RR, 0.65; 95% CI, 0.49- 0.87; p < 0.01). Respiratory failure was higher with ONCABG (RR, 0.74; 95% CI, 0.57-0.97; p = 0.03). New-onset renal failure (p = 0.99), atrial fibrillation (p = 0.27), and myocardial infarction (p = 0.99) were comparable.
Coronary artery bypass in octogenarians can be performed safely with low early mortality. Although off-pump operations reduce the risk of early stroke, all other adverse events are comparable in on- and off-pump coronary artery bypass operations. Data regarding late mortality is at present limited; however, both on- and off-pump procedures appear to produce comparable survival.
关于80岁以上老人非体外循环手术和传统手术结果对比的数据非常有限。因此，我们选择比较80岁以上患者非体外循环冠状动脉搭桥术（OPCABG）和体外循环冠状动脉搭桥术（ONCABG）的早期不良事件。
对多个数据库进行系统回顾，以获取符合搜索标准的原始研究。比较这些队列的终点——早期死亡率、中风、呼吸衰竭、心房颤动和心肌梗死。必要时使用trim-fill调整进行随机效应加权分析。结果以风险比（RRs）和95%置信区间（CIs）表示；p<0.05被认为具有统计学意义。
16项回顾性研究（9744例ONCABG患者和8566例OPCABG患者）纳入系统回顾。与ONCABG患者（3.22±0.41）相比，OPCAGB患者接受的移植血管明显更少（2.54±0.16）。OPCABG和ONCABG队列的早期死亡率分别为4.6%和5.2%，具有可比性（风险比[RR]，0.91；95%CI，0.64-1.28；p=0.598）。ONCABG队列的中风发生率更高（RR，0.65；95%CI，0.49-0.87；p<0.01）。ONCABG的呼吸衰竭发生率更高（RR，0.74；95%CI，0.57-0.97；p=0.03）。新发肾衰竭（p=0.99）、心房颤动（p=0.27）和心肌梗死（p=0.99）具有可比性。
80岁以上老人的冠状动脉搭桥术可以安全进行，早期死亡率较低。虽然非体外循环手术降低了早期中风的风险，但在体外循环和非体外循环冠状动脉搭桥手术中，所有其他不良事件具有可比性。目前关于晚期死亡率的数据有限；然而，体外循环和非体外循环手术似乎都能产生相当的生存率。
