DOI: 10.1097/SA.0000000000000105
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Issn Print: 0039-6206
Publication Date: 2015/02/01
Off-Pump Versus On-Pump Coronary-Artery Bypass Grafting in Elderly Patients
Anno Diegeler; Jochen Borgermann; Utz Kappert; Martin Breuer; Andreas Boning; Adrian Ursulescu; Ardawan Rastan; David Holzhey; Hendrik Treed; Friedrich-Christian Rieb; Philippe Veeckmann; Amjad Asfoor; Wilko Reents; Michael Zacher
Excerpt
The benefits of coronary artery bypass grafting (CABG) without cardiopulmonary bypass in the elderly has yet to be determined. Patients 75 years or older who were scheduled for elective first-time CABG were randomly assigned to undergo the procedure either without cardiopulmonary bypass (off-pump CABG) or with it (on-pump CABG). The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal replacement therapy at 30 days and 12 months after surgery. A total of 2539 patients underwent randomization. Thirty days after surgery, there was no marked difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome (7.8% vs 8.2%; odds ratio, 0.95%; 95% confidence interval [CI], 0.71–1.28) or of the components (death, stroke, myocardial infarction, or new renal replacement therapy). Repeat revascularization took place more often after off-pump CABG than after on-pump CABG (1.3% vs 0.4%; odds ratio, 2.42; 95% CI, 1.03–5.72). At 12 months, no between-group difference existed in the composite end point (13.1% vs 14.0%; hazard ratio, 0.93; 95% CI, 0.76–1.16) or in any of the separate components. Similar results were seen in a per-protocol analysis that excluded the 177 patients who crossed over from the assigned treatment to the other treatment. The investigators concluded that in patients 75 years or older, no marked difference existed between on-pump and off-pump CABG regarding the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal replace ment therapy within 30 days and within 12 months after surgery.
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