Myocardial revascularization in the beating heart without cardiopulmonary bypass in elderly patients with ischemic heart disease

• Main Authors: E. V. Tkachev, P. V. Kleshchev, D. V. Vinogradov, Yu. V. Khrenov, S. V. D'yakov, K. Yu. Berezhnoy
• Format: Article
• Language: Russian
• Published: MONIKI 2017-06-01
• Series: Alʹmanah Kliničeskoj Mediciny
• Subjects: ischemic heart disease; off-pump coronary artery bypass; on-pump coronary artery bypass; elderly
• Online Access: https://www.almclinmed.ru/jour/article/view/540

Rationale: Ageing of population results in an increase in number of aortocoronary bypass interventions in patients with ischemic heart disease aged 65 years and above. This patient group has an increased risk of complications related to systemic inflammatory response to surgical revascularization of the myocardium by on- pump coronary artery bypass (ONCAB). The off-pump coronary artery bypass (OPCAB) enables to avoid complications related to cardiopulmonary bypass; however, there is no consensus on this technique and no clinical guidelines have been developed.Aim: To evaluate short-term results of surgical treatment of elderly patients with ischemic heart disease after OPCAB and after ONCAB.Materials and methods: We performed a retrospective analysis of 61 patients aged above 60 years with multivessel coronary artery disease. The patients from group 1 (n = 31, mean age 72.2 ± 7.3 years) underwent OPCAB, whereas the patients from group 2 (n = 30, mean age 69.3 ± 7.7 years) underwent ONCAB and pharmaco-cold cardioplegia.Results: In the patient group who had underwent OPCAB, there was a significant decrease in the duration of the surgery (4.15 ± 1.2 vs 4.53 ± 1.3 h, p < 0.05), reduction of the duration of mechanical ventilation (11.8 ± 2.3 vs 15.3 ± 1.4 h, p < 0.05), and the number of the transfused RBC doses (0.36 ± 0.9 vs 2.5 ± 1.1 U, p < 0.05). In the early postoperative period, there was a significant difference in the blood loss volume within the 1st day (280 ± 190 mL in group 1 and 359 ± 270 mL in group 2, p < 0.05). The group 1 patients showed a reduction in frequency of heart arrhythmia (4 (12.9%) vs 11 (36.5%) patients, p < 0.05), shorter duration of stay in the resuscitation unit (1.09 ± 0.3 vs 1.46 ± 0.8 days, p < 0.05) and in the department of cardiac surgery (5.06 ± 0.8 vs 7.3 ± 1.1 days, p < 0.05).Conclusion: In the elderly patients, OPCAB could be the intervention of choice allowing for an improvement of short-term postoperative outcomes.