On pump versus off pump coronary artery bypass surgery in patients over seventy years old with triple vessels disease and severe left ventricle dysfunction: focus on early clinical outcomes

ABSTRACT

Cardiovascular disease is the leading reason of morbidity in older people. Coronary artery bypass graft [CABG] surgery is the most common type of operations in world. This study was designed to characterize comparison of early clinical outcome following on pump vs. off pump in patients over 70 years old with triple vessels disease and severe left ventricle dysfunction. 80 patients were divided into two groups In group A [n=40] on pump CABG was performed with hypothermic cardiopulmonary bypass and cold blood cardioplegic arrest and in group B [n=40] the patients had off pump coronary artery bypass [OPCAB] surgery. Exclusion criteria included emergency or urgent operation, combined valve surgery, history of renal insufficiency [Cr >2 mg/dl], stroke. Early postoperative complications such as occurrence, duration and frequency of recurrence of atrial fibrillation were recorded. All patients underwent Holter monitoring after ICU discharge during their hospital stay. The average age of patients was 79.5 +/- 7.5 years. Post operative atrial fibrillation [POAF] occurred in 24 cases [30%]; 17 cases [42.5%] related to on pump CABG group and 7 cases [17.5%] related to OPCAB group [P=0.03]. The frequency of the recurrence of AF in the on pump group was 3.8 +/- 1.3 days and in the off pump group was 2.4 +/- 1.1 days [P=0.02]. ICU stay in on pump group was 3.6 +/- 1.80 days, while for the off pump was 2.5 +/- 0.6 days [P=0.001]. Also hospital stay duration was 8.5 +/- 2.1 days for the on pump group compared to the other group that was 6.34 +/- 1.06 days. Off pump in patients over 70 years old with triple vessels disease and severe LV dysfunction is safer than on pump and can reduce POAF, ICU and hospital stay and some early surgical complications