Short-term results of coronary artery bypass grafting on a beating heart in patients older than 70 years with multi-vessel coronary lesions

Authors: A.A. Melikulov, V.Yu. Merzlyakov, I.V. Klyuchnikov, S.K. Mamedova, R.K. Baychurin, M.F. Akhmedova

Company: Bakoulev National Scientific and Practical Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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Type:  Ischemic heart disease


DOI: https://doi.org/10.24022/1997-3187-2017-11-3-212-221

For citation: Melikulov A.A., Merzlyakov V.Yu., Klyuchnikov I.V., Mamedova S.K., Baychurin R.K., Akhmedova M.F. Short-term results of coronary artery bypass grafting on a beating heart in patients older than 70 years with multi-vessel coronary lesions. Kreativnaya Kardiologiya (Creative Cardiology). 2017; 11 (3): 212–21 (in Russ.). DOI:10.24022/1997-3187-2017-11-3-212-221

Received / Accepted:  June 8, 2017 / June 15, 2017

Keywords: Melikulov A.A. Merzlyakov V.Yu. Klyuchnikov I.V. Mamedova S.K. Baychurin R.K. Akhmedova M.F.

Full text:  

 

Abstract

Objective. Evaluation of early post-operative results of coronary bypass grafting in patients with ischemic heart disease over 70 years with high surgical risk operated by off-pump or on-pump techniques.

Material and methods. This study included 773 patients older than 70 years with multi-vessel coronary artery disease. 405 patients were operated using off-pump coronary artery bypass (OPCAB), and 368 patients with onpump techniques. The average age of patients in OPCAB group was 74.7±3.7 years old, in the on-pump group 75.2±3.5 years old (р=0,068). Preoperative risk stratification was performed by EuroSCORE and EuroSCORE II scales, which had no significant difference between groups.

Results. Mortality in OPCAB group was 3.2% (13 patients), in on-pump group 6.8% (25 patients) (р=0.023). The main combo end point was death, acute myocardial infarction, stroke, acute renal failure with hemodialysis, repeat myocardial revascularization. At early postoperative period end point was 10.3% at on-pump group, and 4.9% at OPCAB group, the difference was statistically significant (р=0.005). Moreover the frequency of acute renal failure occurrence requiring hemodialysis and stroke in on-pump group was more than 3 times higher than in the OPCAB group.

Сonclusion. Performing coronary artery bypass grafting on a beating heart in patients older than 70 years is an effective, safe and a justifiable method that leads to a decrease in the incidence of deaths and postoperative complications, such as acute myocardial infarction, acute renal failure, stroke, in comparison to on-pump surgery.

References

  1. Dalén M., Ivert T., Holzmann M.J., Sartipy U. Coronary artery bypass grafting in patients 50 years or younger: a Swedish Nationwide Cohort Study. Circulation. 2015; 131: 1748–54.

  2. Saito A., Motomura N., Miyata H., Takamoto S., Kyo S., Ono M. Age-specific risk stratification in 13488 isolated coronary artery bypass grafting procedures. Interact. CardioVasc. Thorac. Surg. 2011; 12: 575–81.

  3. Bockeria L.A., Merzlyakov V.Yu., Klyuchnikov I.V., Sigaev I.Yu., Drozdov V.V., Skopin A.I. et al. Assessment of immediate results of surgical treatment of coronary artery disease in elderly patients. Annaly Khirurgii (Annals of Surgery, Russian journal). 2010; 1: 59–64 (in Russ.).

  4. Houlind K., Kjeldsen B.J., Madsen S.N., Rasmussen B.S., Holme S.J., Pallesen P.A. et al., DOORS Study Group. OPCAB surgery is cost-effective for elderly patients. Scand. Cardiovasc. J. 2013; 47: 185–92.

  5. Moller C.H., Perko M.J., Lund J.T. et al. Graft patency after off-pump versus on-pump coronary artery surgery in high-risk patients. Scand. Cardiovasc. J. 2010; 44: 161–7.

  6. Cooper E.A., Edelman J.J., Black D., Brereton R.J., Ross D.E., Bannon P.G. et al. An aortic off-pump coronary artery bypass grafting in the elderly and very elderly. Heart Lung. Circ. 2013; 22: 989–95.

  7. Garg A.X., Devereaux P.J., Yusuf S., Cuerden M.S., Parikh C.R., Coca S.G. et al. CORONARY Investigators. Kidney function after off-pump or on-pump coronary artery bypass graft surgery: a randomized clinical trial. JAMA. 2014; 311: 2191–8.

  8. Hattler B., Messenger J.C., Shroyer A.L. et al. Offpump coronary artery bypass surgery is associated with worse arterial and saphenous vein graft patency and less effective revascularization: results from the Veterans Affairs Randomized On/Off Bypass (ROOBY) trial. Circulation. 2012; 125: 2827–35.

  9. Straka Z., Widimsky P., Jirasek K., Stros P., Votava J., Vanek T. et al. Off-pump versus on-pump coronary surgery: final results from a prospective randomized study PRAGUE-4. Ann. Thorac. Surg. 2004; 77: 789–93.

  10. Diegeler A., Börgermann J., Kappert U., Breuer M., Böning A., Ursulescu A. et al. Off-pump versus onpump coronary-artery bypass grafting in elderly patients. N. Engl. J. Med. 2013; 368: 1189–98.

  11. Marui A., Okabayashi H., Komiya T., Tanaka S., Furukawa Y., Kita T. et al. Benefits of off-pump coronary artery bypass grafting in high-risk patients. Circulation. 2012; 126: S151–7.

  12. Pawlaczyk R., Swietlik D., Lango R., Rogowski J. Off-pump coronary surgery may reduce stroke, respiratory failure, and mortality in octogenarians. Ann. Thorac. Surg. 2012; 94: 29–37.

  13. Hughes S. Off-pump/on-pump CABG: still no consensus. American College of Cardiology (ACC) 2013. Scientific Sessions Medscape. San Francisco, March 9–11, 2013.

  14. Wareing T.H., Davila-Roman V.G., Barzilai B. et al. Management of the severely atherosclerotic ascending aorta during cardiac operations: a strategy for detection and treatment. J. Thorac. Cardiovasc. Surg. 1992; 103: 453–62.

  15. Cannon L.A., Marshall J.M. Cardiac disease in the elderly population. Clin. Geriatr. Med. 1993; 9: 499–525.

  16. Taggart D.P. Incomplete revascularization: appropriate and inappropriate. Eur. J. Cardiothorac. Surg. 2012; 41.

  17. Seabra V.F., Alobaidi S., Balk E.M., Poon A.H., Jaber B.L. Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized controlled trials. Clin. J. Am. Soc. Nephrol. 2010; 5: 1734–44.

  18. Koutlas T.C., Yeatman M., Elbeer J.R., Williams J.M., Moran J.F., Francalancia N.A., Chitwood W.R. Jr. Myocardial revascularization in the elderly using beating heart coronary artery bypass surgery. Ann. Thorac. Surg. 2000; 69: 1042–7.

  19. Puskas J.D., Wright C.E., Ronson R.S., Brown W.M. III, Gott J.P., Guyton R.A. Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients. Heart Surg. Forum. 1999; 2: 216–21.

  20. Van Dijk D., Nierich A.P., Jansen E.W.L. et al. Early outcome after off-pump versus on-pump coronary bypass surgery. Circulation. 2001; 104: 1761–6.

  21. A Japanese Associate for Coronary Artery Surgery (JACAS). Coronary artery surgery results 2013, in Japan. Ann. Thorac. Cardiovasc. Surg. 2014; 20: 332–4.

About Authors

  • Melikulov Alisher Almardonovich, Cand. Med. Sc., Cardiovascular Surgeon, orcid.org/0000-0002-5164-9702;
  • Merzlyakov Vadim Yur’evich, Dr. Med. Sc., Head of Department, orcid.org/0000-0001-5638-3723;
  • Klyuchnikov Ivan Vyacheslavovich, Dr. Med. Sc., Professor, Chief Researcher, orcid.org/0000-0002-8652-9639;
  • Mamedova Sevindzh Kamilovna kizy, Cand. Med. Sc., Junior Researcher, orcid.org/0000-0002-5696-0807;
  • Baychurin Renat Kamil’evich, Cardiovascular Surgeon, orcid.org/0000-0001-6288-3724;
  • Akhmedova Madina Fatkhullaevna, Cand. Med. Sc., Cardiologist, orcid.org/0000-0002-6184-6742

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery