Off-pump Coronary Artery Bypass Grafting in Elderly and High-risk Patients – A Review

Cooper, Ellis; Edelman, James; Wilson, Michael K.; Bannon, Paul G.; Vallely, Michael P.

doi:10.1016/j.hlc.2011.07.006

Cited by 15 publications

(5 citation statements)

References 87 publications

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“…In a ten year prospective study of 8000 patients with PAD undergoing CABG, it was seen that they had a higher incidence of various intra-and post-operative complications including arrhythmias, stroke, pulmonary complications, low cardiac output state, longer hospital stay, infections, and acute renal failure. These results have been borne out by other studies as well [60][61][62][63].…”

Section: Peripheral Arterial Disease and Cabg Outcomessupporting

confidence: 73%

Impact of Renal Dysfunction and Peripheral Arterial Disease on Post-Operative Outcomes After Coronary Artery Bypass Grafting

Chaudhry¹,

Omar²,

Latif³

2013

Artery Bypass

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Cockcroft-Gault equation: Creatinine Clearance (ml/min) = [([140 − age] × weight [kg])/72 × serum creatinine (mg/dl)] (× 0.85 for women), MDRD equation: GFR (mL/min/1.73 m 2) = 175 × (serum creatinine)-1.154 × (Age)-0.203 × (0.742 if female) × (1.212 if African American) (conventional units) Creatinine clearance or glomerular filtration rate (GFR) represents renal function. Declining values represent a decline in renal function. Stage 1 refers to glomerular filtration rate (GFR) >90 ml/min and is generally asymptomatic. GFR between 60-90 ml/min is stage 2 CKD. Stage 3 is GFR between 30 and 60 ml/min and is further subdivided into Stage 3A (GFR 45-60 ml/min) and Stage 3B (GFR 30-45 ml/min). Stage 4 is defined by GFR between 15-30 ml/min while GFR <15 ml/min signifies Stage 5 and is considered an indication for renal replacement therapy i.e. dialysis. The most common etiological factors for CKD include diabetes mellitus and hypertension resulting in diabetic nephropathy and hypertensive nephrosclerosis, respectively.

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Section: Peripheral Arterial Disease and Cabg Outcomessupporting

confidence: 73%

Impact of Renal Dysfunction and Peripheral Arterial Disease on Post-Operative Outcomes After Coronary Artery Bypass Grafting

Chaudhry¹,

Omar²,

Latif³

2013

Artery Bypass

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“…Patients with advanced age have a smaller physiological reserve, albeit more comorbidity such as diabetes, cerebrovascular disease, COPD, and renal insufficiency, which make them more susceptible to the ill-effects of CPB and thereby more prone to the development of perioperative complications following CABG, particularly stroke and acute renal failure (54,55). Therefore, off-pump CABG has been adopted by several cardiac surgeons as a modality that could reduce the occurrence of perioperative complications, especially those caused by the implementation of CPB (34,(56)(57)(58). One of the initial reports from the London Health Sciences Centre, Canada, which compared 30 elderly patients undergoing off-pump CABG to 60 elderly patients undergoing on-pump CABG, revealed a significant reduction in low output syndrome and AF and a non-significant trend towards lower postoperative stroke rates in the latter group, which translated into a significant reduction in hospital resource utilization and four times lower prevalence of adverse economic outcomes in off-pump CABG patients (59).…”

Section: Agementioning

confidence: 99%

Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice

Davierwala

2016

J. Thorac. Dis.

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Coronary artery bypass grafting (CABG) can be performed conventionally using cardiopulmonary bypass (CPB) and aortic clamping or on a beating heart (BH) without the use of CPB, the so-called off-pump CABG. Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB. Ever since the conception of off-pump CABG, the never-ending debate about which technique of CABG is safe and efficacious continues to date. Several randomized controlled trials (RCTs) have been conducted that have either favored on-pump CABG or have failed to show a significant difference in outcomes between the two techniques. However, these RCTs have been fraught with claims that they do not represent the majority of patients undergoing CABG in real world practice. Therefore, assessment of the benefits and drawbacks of each technique through observational and registry studies would be more representative of patients encountered in daily practice. The present review examines various retrospective studies and meta-analyses of observational studies that compare the early and long-term outcomes of off- and on-pump CABG, which assesses their safety and efficacy. Additionally, their outcomes in older patients, females, and those with diabetes mellitus, renal dysfunction, presence of ascending aortic disease, and/or acute coronary syndrome (ACS) have also been discussed separately. The general consensus is that early results of off-pump CABG are comparable to or in some cases better than on-pump CABG. However, on-pump CABG provides a survival benefit in the long term according to a majority of publications in literature.

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“…Despite these remarkable advances, over 40% of the very elderly manifest cardiovascular disease and , 3,4], now increasing from 7.7% to over 11% of total CABG procedures in the Society of Thoracic Surgeons (STS) database [5; David Shahian, personal communication]. Critical analysis of CABG surgery in octogenarians requires a clear understanding of the most current shortterm and long-term outcomes, the unique physiologic challenges encountered operating on the very elderly, the demonstrable impact on quality of life (QOL), the emerging role of viable alternatives, and the sobering realities of costs.…”

Section: Demographicsmentioning

confidence: 99%

Do octogenarians benefit from coronary artery bypass surgery

Kurlansky

2012

Current Opinion in Cardiology

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Although it is clear that CABG surgery in octogenarians can be accomplished with increasingly good results, future research will need to focus on what specific surgical strategies are most appropriate for this elderly cohort; how the collaborative 'Heart Team' approach can be most effectively applied to determination of the most appropriate therapeutic course for these complex, frequently high-risk patients; what strategies can be applied to best manage and possibly reverse patient frailty; and what economic models most meaningfully inform clinical and public policy decision-making.

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Off-pump Coronary Artery Bypass Grafting in Elderly and High-risk Patients – A Review

Cited by 15 publications

References 87 publications

Impact of Renal Dysfunction and Peripheral Arterial Disease on Post-Operative Outcomes After Coronary Artery Bypass Grafting

Impact of Renal Dysfunction and Peripheral Arterial Disease on Post-Operative Outcomes After Coronary Artery Bypass Grafting

Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice

Do octogenarians benefit from coronary artery bypass surgery

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