13. MYOCARDIAL REVASCULARIZATION IN THE ELDERLY: IMPROVED RESULTS USING BEATING HEART CORONARY ARTERY BYPASS SURGERY
Theodore C. Koutlas, Joseph R. Elbeery*, J. Mark Williams*, Jon F. Moran, Nicola A. Francalancia, W. Randolph Chitwood, Jr.*
Division of Cardiothoracic Surgery, East Carolina University, School of Medicine
Greenville, North Carolina, USA
BACKGROUND
Beating heart r "off-pump" coronary artery bypass (OP-CAB) has become an accepted method of myocardial revascularization by reducing the perioperative morbidity related to cardiopulmonary bypass (CPB). However, the efficacy of OP-CAB has not been well established in the elderly patient population.
MATERIAL AND METHODS
We reviewed the results of 265 consecutive coronary artery bypass (CAB) procedures performed in patients 75 years and older at Pitt County Memorial Hospital from January 1996 to May 1999. OP-CABs were performed in 44 patients, either through a median sternotomy or an anterior thoracotomy, and these results were compared to the 221 patients who underwent CAB using CPB. A chi-square test or t-test was used for statistical analysis, and the data were expressed either as a percentage or mean
± std. dev. Patient age for both groups was 79± 3 years; ejection fraction was slightly lower in the CPB group (49%± 13 vs 54%± 11, P<0.05). Other preoperative risk factors were similar.RESULTS
Postoperatively, there was no difference in myocardial infarction, pneumonia, or renal failure. Other results were as follows:
| 30-day mortality | Stroke | Postop Atrial Fib | Postop length of stay | ||||||
| CPB | 7.7%(17/221)* | 8.1%(18/221) | 27%(59/221) | 8.4± 9.1 days*
| OP-CAB | 0% (0/44)* | 2.3%(1/44) | 18%(8/44) | 4.2± 1.8 days* | |
Operative mortality and length of stay were significantly improved using beating-heart procedures, possibly due to the avoidance of CPB in this patient population.
CONCLUSION
Our data demonstrate that OP-CAB is a safe and efficacious method of myocardial revascularization in the elderly, and should be considered preferential in these patients when applicable.
