Lee Sang On, Lee Heemoon, Cho Yang Hyun, Jeong Dong Seop, Lee Young Tak, Kim Wook Sung
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea.
Korean J Thorac Cardiovasc Surg. 2019 Jun;52(3):155-161. doi: 10.5090/kjtcs.2019.52.3.155. Epub 2019 Jun 5.
Coronary artery bypass grafting (CABG) is being offered increasingly frequently to octogenarians. However, old age is known to be an independent risk factor in CABG. The aim of this study was to compare the outcomes of off-pump coronary artery bypass (OPCAB) between octogenarians and septuagenarians.
We retrospectively reviewed the data of 1,289 consecutive patients aged ≥70 years who underwent OPCAB at a single institution between 2001 and 2016. We compared the outcomes of 115 octogenarians and 1,174 septuagenarians. Using propensity score matching, based on preoperative clinical characteristics, 114 octogenarians were matched with 338 septuagenarians.
Propensity score analysis revealed that the incidence of acute kidney injury (14.9% vs. 7.9%, p=0.028) and respiratory complications (8.8% vs. 4.2%, p=0.040) was significantly higher in octogenarians. The early mortality rate (2.6% vs. 1.0%, p=0.240) and 1-year survival rate (89.5% vs. 94.4%, p=0.097) were not statistically significant between the groups. However, the 5-year survival rate (67.3% vs. 79.9%, p<0.001) was significantly lower in octogenarians. Previous myocardial infarction and a left ventricular ejection fraction ≤35% were associated with a poor 1-year survival rate.
Early and 1-year outcomes of OPCAB in octogenarians were tolerable when compared with those in septuagenarians. OPCAB could be a suitable option for octogenarians.
冠状动脉旁路移植术（CABG）越来越频繁地应用于八旬老人。然而，高龄是冠状动脉旁路移植术的一个独立危险因素。本研究的目的是比较八旬老人和七旬老人非体外循环冠状动脉旁路移植术（OPCAB）的结果。
我们回顾性分析了2001年至2016年间在单一机构接受OPCAB的1289例年龄≥70岁的连续患者的数据。我们比较了115例八旬老人和1174例七旬老人的结果。基于术前临床特征，采用倾向评分匹配法，将114例八旬老人与338例七旬老人进行匹配。
倾向评分分析显示，八旬老人急性肾损伤（14.9%对7.9%，p=0.028）和呼吸并发症（8.8%对4.2%，p=0.040）的发生率显著更高。两组之间的早期死亡率（2.6%对1.0%，p=␣0.240）和1年生存率（89.5%对94.4%，p=0.097）无统计学意义。然而，八旬老人的5年生存率（67.3%对79.9%，p<0.001）显著更低。既往心肌梗死和左心室射血分数≤35%与1年生存率低相关。
与七旬老人相比，八旬老人OPCAB的早期和1年结果是可耐受的。OPCAB可能是八旬老人的合适选择
