Biblioteca Virtual en Salud

To assess the influence of off-pump coronary artery surgery on early and midterm clinical results in elderly patients. Coronary artery bypass grafting [CABG] in elderly patients is associated with perioperative mortality and morbidity rates higher than those observed in young aged patients. The avoidance of cardiopulmonary by pass [CPB] in this population is potentially beneficial. This a retrospective study consisted of 1007 CABG patients. Of these 583 patients underwent CABG without CPB [group A] and 424 patients underwent CABG with CPB [group B]. Patients that converted from off-pump to CPB ere included in group A. Most of the preoperative variables ere comparable between the two groups. Group A patients had more preoperative cerebrovascular accident [p=0.044], carotid artery disease [p=0.025] and renal impairment [p=0.03]. Group B had more female patients [p=0.045], more patients with low EF [p=0.007] and more patients with multivessel disease [P=0.031]. 33[5.7%] patients were converted to CPB. Early mortality was 3.7% [group A, 2.6%, Group B, 5.2%; p=0.045, acute myocardial infarction incidence was 2.38% [group A, 1.5%; group B, 35%; p=0.041], cerebrovascular accident incidence was 0.99% [group A, 0.34%; group B, 1.88%; p=0.0.34], and early major events incidence was 9.9% [group A, 7.9%; group B, 13.2%; p=0.006]. Group A had a short ICU and hospital stay than group B, Stepwise logistic regression analysis showed that CPB was an independent risk factor for higher mortality [Odds Ratio "OR", 2.2; p=0.021 7], higher incidence of acute myocardial infarction [Odds Ratio, 2.5; p=0.0185], and higher incidence of early major events [Odd Ratio, 1.8, p=0.0034]. Mid-term mortality or cardiac-related events were similar in the two groups. In elderly patients, off-pump CABG is safe-procedure that facilitates early recovery and reduces the incidence of postoperative mortality and morbidity. At mid-term follow up, the incidence of mortality and cardiac-related events were low in both group supporting a more aggressive policy of coronary revascularization in elderly patients