eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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SCImago Journal & Country Rank
2/2019
vol. 15
 
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abstract:
Original paper

Prediction of complications and death in octogenarians with left main coronary artery disease after coronary artery bypass implantation – off-pump, on-pump and minimally invasive techniques comparison

Anetta Kowalczuk-Wieteska
,
Monika Parys
,
Rafał Pawlaczyk
,
Krzysztof Filipiak
,
Marek Cisowski
,
Andrzej Bochenek
,
Zdzisław Tobota
,
Bohdan Maruszewski
,
Michał Zembala
,
Marian Zembala

Adv Interv Cardiol 2019; 15, 2 (56): 218–225
Online publish date: 2019/06/26
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Introduction
Off-pump coronary artery bypass grafting is considered potentially more effective than on-pump surgery in elderly patients.

Aim
To compare the early and long-term results of these techniques in patients ≥ 80 years of age with left main coronary artery disease.

Material and methods
All patients ≥ 80 years of age (N = 3648) who were reported to the Polish National Registry of Cardiac Surgery Procedures between 2006 and 2016 and underwent primary, isolated coronary artery bypass surgery were included in the study. The patients were divided into 2 groups: group A – without significant left main stenosis (LMS) (n = 2094) and B group – with LMS ≥ 50% (n = 1524). The groups were compared according to the type of surgery: on-pump (A = 1107 vs. B = 891), off-pump (A = 908 vs. B = 616) and MIDCAB (A = 79 vs. B = 17).

Results
There were significant differences in preoperative status between the groups in the whole cohort, which were not observable after propensity score matching. The in-hospital mortality was significantly higher in the LMS group operated on-pump (10.5% vs. 7.0%; p = 0.01) and non-significant in the off-pump group (5.1% vs. 5.7%; p = 0.78), as well as in the MIDCAB subgroup (5.9% vs. 5.1%; p = 0.64). 10-year survival in all subgroups was comparable and remained at a level of 50–60%. The mean entire cohort follow-up was 3.4 ±2.7 vs. 3.7 ±2.8 years (p = 0.2).

Conclusions
Off-pump coronary bypass grafting may optimize the outcomes in elderly patients with significant left main stenosis. Octogenarians surgically treated for coronary artery disease, despite increased post-operative risks, present encouraging long-term survival.

keywords:

octogenarians, left main disease, coronary artery bypass

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