Bristol Heart Institute, University of Bristol, Bristol, UK.
J Card Surg. 2022 Dec;37(12):4705-4712. doi: 10.1111/jocs.17068. Epub 2022 Nov 2.
Coronary artery bypass grafting (CABG) remains a good revascularization strategy in octogenarians with excellent clinical outcomes and quality of life postoperatively. However, the benefits of off-pump over on-pump CABG in the elderly population are still controversial. We investigated this issue in the UK National Audit database.
We retrospectively analyzed all octogenarians undergoing nonemergency, isolated CABG from 1996 to 2019. Propensity score matching (PSM) was conducted to adjust for imbalance in the baseline characteristics between the off-pump and on-pump groups. Primary outcome was in-hospital mortality and postoperative cerebrovascular accidents. Secondary outcomes were bleeding requiring reoperation, deep sternal wound infection, and postoperative dialysis.
A total of 6436 patients were included for analysis. No differences were observed between off- and on-pump group in-hospital mortality (4% vs. 3.8%, p = .89), return to theater rate (5.4% vs. 6.2%, p = .16) and incidence of deep sternal wound infection (1.1% vs. 1.6%, p = .34). However, octogenarian undergoing off-pump CABG were less likely to experience postoperative transient ischemic attack (TIA)/stroke (1.4% vs. 2.3%, p = .004) but more likely to require renal dialysis (4.8% vs. 3.5%, p = .03).
The data show similar in-hospital mortality in octogenarians regardless of the revascularization technique used. Off-pump when compared with on-pump CABG is associated with a lower incidence in postoperative neurological events but a higher need for renal dialysis.
在 80 岁以上的患者中，冠状动脉旁路移植术（CABG）仍然是一种良好的血运重建策略，术后临床结果和生活质量优异。然而，非体外循环与体外循环 CABG 在老年人群中的益处仍存在争议。我们在英国国家审计数据库中调查了这一问题。
我们回顾性分析了 1996 年至 2019 年间所有接受非紧急、单纯 CABG 的 80 岁以上患者。采用倾向评分匹配（PSM）来调整体外循环与非体外循环组之间的基线特征不平衡。主要结局为住院期间死亡率和术后脑血管意外。次要结局为需要再次手术的出血、深部胸骨伤口感染和术后透析。
共纳入 6436 例患者进行分析。非体外循环组与体外循环组在住院期间死亡率（4%与 3.8%，p=0.89）、重返手术室率（5.4%与 6.2%，p=0.16）和深部胸骨伤口感染发生率（1.1%与 1.6%，p=0.34）方面无差异。然而，接受非体外循环 CABG 的 80 岁以上患者发生术后短暂性脑缺血发作（TIA）/中风的可能性较低（1.4%与 2.3%，p=0.004），但更有可能需要进行肾脏透析（4.8%与 3.5%，p=0.03）。
数据表明，无论使用哪种血运重建技术，80 岁以上患者的住院期间死亡率相似。与体外循环 CABG 相比，非体外循环 CABG 术后神经事件发生率较低，但需要肾脏透析的可能性较高。
