Coronary Revascularization Surgical Techniques and Outcomes in Octogenarians: A Multicenter Retrospective Matched Study

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2025-08-19 DOI:10.1155/jocs/5329892

Amber Malhotra, Md. Anamul Islam, Kyle A. McCullough, John B. Eisenga, Giuseppe Tavilla, Ramachandra Reddy, Daniel Beckles, Thomas d’Amato, Robert L. Smith, Charles S. Roberts, Michael J. Mack, J. Michael DiMaio

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引用次数: 0

Abstract

Introduction: Coronary artery bypass grafting (CABG) is commonly performed for treating coronary artery disease (CAD) in octogenarians. This entails higher risk and resource utilization compared to younger patients. This retrospective multicenter study evaluates CABG outcomes in octogenarians, with a particular focus on the impact of off-pump (OPCAB) versus on-pump (ONCAB) CABG techniques.

Methods: We conducted a retrospective analysis of isolated OPCAB and ONCAB procedures in octogenarians from January 1, 2015, to June 30, 2023, across 8 centers within a single health system. All cases submitted to the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were included. The primary outcome was 30-day mortality; secondary outcomes included STS-defined postoperative complications. We performed a stabilized inverse probability treatment weighted (sIPTW) matching technique to balance baseline covariates between the two groups.

Results: Across eight centers, 470 (7%) CABG procedures were performed in octogenarians, with 207 (44%) underwent OPCAB and 263 (56%) ONCAB. Prior to matching, overall 30-day all-cause mortality rate was 6.6% in octogenarians. After sIPTW matching, 30-day mortality (primary outcome) rates were comparable between OPCAB and ONCAB (2.4% vs. 4.4%; p = 0.71). However, OPCAB was associated with lower rates of composite complications (28% relative risk reduction (RRR), p = 0.003), including pneumonia (89% RRR, p = 0.023), atrial fibrillation (30% RRR, p = 0.013), and discharge-to-acute care facilities (ACFs) (36% RRR, p = 0.003). Resource utilization was also lower in the OPCAB group, with shorter median hospital stays (6 [3–7] vs. 7 [6–9] days, p = 0.002) and reduced ventilator time (4.3 [0.8–9] vs. 8.4 [4.7–21] hours, p = 0.009).

Conclusion: In octogenarians, OPCAB and ONCAB found comparable 30-day mortality. However, OPCAB was associated with fewer complications, shorter hospital stays, reduced ventilator hours, lower blood transfusion requirements, and higher discharge-to-home rates, suggesting potential advantages in resource utilization and patient recovery.

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80岁老人冠状动脉血管重建术的手术技术和结果：一项多中心回顾性匹配研究

导读：冠状动脉旁路移植术（CABG）是治疗老年冠状动脉疾病（CAD）的常用方法。与年轻患者相比，这需要更高的风险和资源利用率。这项回顾性多中心研究评估了80多岁老人CABG的结果，特别关注了非泵送（OPCAB）与泵送（ONCAB） CABG技术的影响。方法：我们回顾性分析了2015年1月1日至2023年6月30日在同一个卫生系统内的8个中心进行的80多岁老人的OPCAB和ONCAB隔离手术。所有提交给胸外科学会（STS）成人心脏外科数据库的病例均被纳入。主要结局为30天死亡率；次要结局包括sts定义的术后并发症。我们采用了稳定的逆概率处理加权（sIPTW）匹配技术来平衡两组之间的基线协变量。结果：在8个中心中，470例（7%）老年患者接受了CABG手术，207例（44%）接受了OPCAB， 263例（56%）接受了ONCAB。在匹配之前，80多岁老人的30天全因死亡率为6.6%。在sIPTW匹配后，OPCAB和ONCAB的30天死亡率（主要结局）具有可比性（2.4% vs. 4.4%; p = 0.71）。然而，OPCAB与较低的复合并发症发生率（相对风险降低28% (RRR), p = 0.003）相关，包括肺炎（89% RRR, p = 0.023）、房颤（30% RRR, p = 0.013）和出院到急性护理机构（ACFs）（36% RRR, p = 0.003）。OPCAB组的资源利用率也较低，中位住院时间较短（6[3-7]对7[6 - 9]天，p = 0.002），呼吸机时间较短（4.3[0.8-9]对8.4[4.7-21]小时，p = 0.009）。结论：在80多岁的老年人中，OPCAB和ONCAB的30天死亡率相当。然而，OPCAB与更少的并发症、更短的住院时间、更少的呼吸机时间、更低的输血需求和更高的出院回家率相关，这表明在资源利用和患者康复方面具有潜在优势。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.