Prognostic Comparison Of Cardiopulmonary Bypass And Off - Pump Coronary Artery Bypass Grafting In Elderly Women And Elderly Patients With Renal Insufficiency

Part ⅠOn-pump Versus Off-pump Coronary Artery Bypass Grafting in Elderly Female PatientsObjective:Female and advanced age are risk factors in patients with coronary artery bypass grafting (CABG). However, Limited information exists with respect to the impact of female and advanced age on short- and long-term outcomes of off-pump CABG verse on-pump CABG. The aim of the present study was to compare the results of off-pump to on-pump revascularization in this high-risk population.Methods:A retrospect review was conducted in 763 women aged more than 65 years undergoing isolated CABG in Fuwai Hospital from January 1999 to December 2008. 331 patients underwent on-pump CABG and 432 patients underwent off-pump CABG. Multivariable logistic regression analyses and Cox proportional hazard analyses were used to compare the short-and long-Term outcomes between the two groups. The primary outcomes were 30-day mortality and long-term major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke, myocardial infarction, or repeat revascularization. The secondary outcomes were in-hospital morbidities.Results:The baseline characteristics showed that off-pump group were significant older (69.57±3.48 vs 68.65±3.17, p<0.001), with the higher rate of cerebrovascular accident (p=0.023), less angina (p<0.001), emergency operation (p=0.015) and family history of coronary heart disease (p=0.012). Off-pump group had fewer numbers of venous distal anastomoses (p<0.001) and higher in-complete revascularization (p<0.001). The 30-day mortality rate was 2.7% for the on-pump group and 0.5%f or the off-pump group. Logistic regression model comparison indicated that Off-pump group was associated with significantly reduced 30-day mortality (p=0.038), prolonged mechanical ventilation (p<0.001), blood transfusion (p<0.001), renal failure (p=0.022), re-exploration for bleeding (p=0.021), pulmonary complications (p<0.001). The combined postoperative morbidities (p=0.110) were similar between the two groups. Cox proportional hazard analyses showed that there were no significant differences in the long-term survival (p=0.477), stroke (p= 0.248), myocardial infarction (p=0.127) and repeated revascularization (p= 0.675).Conclusion:Our study showed that off-pump CABG was associated with reduced the rate of 30-day mortality and postoperative morbidities in elderly female patient. However, off-pump CABG was of no benefit in the long-term mortality and MACCE. The off-pump protective effect on early outcomes was not presented in the long-term follow-up.Part IIOn-pump Versus Off-pump Coronary Artery Bypass Grafting in Elderly Patients with Renal DysfunctionObjective:Renal dysfunction and advanced age are risk factors in patients with coronary artery bypass grafting (CABG). However, Limited information exists with respect to the impact of renal dysfunction and advanced age on prognosis of off-pump CABG verse on-pump CABG. The aim of the present study was to compare the results of off-pump to on-pump revascularization in this high-risk population.Methods:A retrospect review was conducted in 738 renal dysfunction patients aged more than 65 years undergoing isolated CABG in Fuwai Hospital from January 1999 to December 2008.320 patients underwent on-pump CABG and 418 patients underwent off-pump CABG. The estimated glomerular filtration rate (eGFR) was estimated to determine the degrees of renal failure. Renal dysfunction was defined as eGFR< 60 ml/min/1.73m2. Multivariable logistic regression analyses and Cox proportional hazard analyses were used to compare the short- and long-Term outcomes between the two groups. The primary outcomes were 30-day mortality and long-term major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke, myocardial infarction, or repeat revascularization. The secondary outcomes were in-hospital morbidities.Results:The baseline characteristics showed that off-pump group were significant older (71.29±4.15 vs 70.25±3.87, p<0.001), with the higher left ventricular ejection fraction (p=0.013), less angina (p<0.001) and emergency operation (p=0.011). Off-pump group had fewer numbers of distal anastomoses (p<0.001). The 30-day mortality rate was 4.4% for the on-pump group and 1.4% for the off-pump group. Logistic regression model comparison indicated that Off-pump group was associated with significantly reduced 30-day mortality (p=0.033), blood transfusion (p<0.001), prolonged mechanical ventilation (p<0.001), Low cardiac output syndrome (p=0.006), wood infection (p=0.033), pulmonary complications (p<0.001), re-exploration for bleeding (p=0.005) and combined postoperative morbidities (p=0.009). Cox proportional hazard analyses showed that there were no significant differences in the long-term survival (p=0.320), stroke (p= 0.672), myocardial infarction (p=0.600) and repeated revascularization (p= 0.359).Conclusion:Our study showed that off-pump CABG was associated with reduced the rate of 30-day mortality and postoperative morbidities in elderly patient with renal dysfunction. However, off-pump CABG was of no benefit in the long-term mortality and MACCE. The off-pump protective effect on early outcomes was not presented in the long-term follow-up.