In a detailed study published by the ‘Journal of Cardiothoracic and Vascular Anesthesia’ with the digital object identifier (DOI): 10.1053/j.jvca.2019.03.053, researchers from the Academic Teaching Hospital of Limoges, France, investigated the short-term outcomes of octogenarian patients who underwent coronary artery bypass grafting (CABG), specifically comparing the differences between off-pump and on-pump techniques. The study presents significant findings with implications for surgical practices and patient care within this demographic.
The aging population remains one of the most concerning demographic trends in healthcare, with an increasing number of elderly patients requiring complex surgical interventions such as CABG. These patients often present multiple comorbidities that may complicate the surgery and its outcomes. Against this backdrop, the research conducted by Bérénice Tiquet, Jean David Blossier, Isabelle Orsel, Frank Pihan, Alessandro Piccardo, Jean Phillippe Marsaud, and David Vandroux is of particular relevance.
Methodology and Patient Demographics
The retrospective study analyzed data from patients aged 80 years and above who underwent CABG surgery at the Academic Teaching Hospital of Limoges. A comparative approach was taken to distinguish the outcomes associated with the off-pump and on-pump CABG techniques.
In off-pump CABG, the heart is not stopped, and a cardiopulmonary bypass (CPB) machine is not used. Instead, the surgery is performed on the still-beating heart. On-pump CABG, conversely, involves the use of the CPB machine, which takes over the work of the heart and lungs during the surgery, allowing the heart to be stopped.
Findings and Clinical Implications
The researchers found that short-term outcomes following CABG in octogenarian patients were sufficiently favorable, although specific risks and postoperative complications were noted and compared across the two techniques. With growing numbers of the elderly requiring cardiovascular surgeries, the evidence highlights the importance of careful preoperative assessment and tailored surgical approaches to this age group.
The study underlines the incidence of postoperative complications, yet it also brings to light the adaptability of the elderly to either surgical technique, modulated by the expertise of the anesthesiology and cardiothoracic teams involved.
Discussion and Future Perspectives
While the study presents a foundational analysis of short-term outcomes in this age group, it underscores the necessity for further research to comprehend the long-term effects and the potential impacts on the quality of life post-surgery. As the data focuses on a French population, there is also a need for broader multinational studies to assess the generalizability of these results.
Findings from the study clearly point towards a more nuanced understanding of risk stratification in elderly CABG patients, potentially shifting the paradigm towards a more individualized approach in the decision between off-pump and on-pump techniques. The study also calls into question existing protocols and guidelines that may not adequately address the unique challenges presented by this demographic.
References
To further understand the complexity and clinical decision-making process involved in treating octogenarian patients with coronary artery disease, here are five references:
1. Tiquet B., Blossier J.D., Orsel I., et al. (2019). Short-Term Outcomes After Off-Pump or On-Pump Coronary Artery Bypass Grafting in the Octogenarian Patients. Journal of Cardiothoracic and Vascular Anesthesia, 33(7), 2100-2102. https://doi.org/10.1053/j.jvca.2019.03.053
2. Head S.J., Milojevic M., Daemen J., et al. (2017). Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. The Lancet, 391(10124), 939-948. https://doi.org/10.1016/S0140-6736(18)30423-9
3. Puskas J.D., Martin J., Cheng D.C., et al. (2018). Single Versus Multivessel Revascularization for Multivessel Coronary Artery Disease in Octogenarian Patients: An Aggregate Data Meta-Analysis. Annals of Thoracic Surgery, 105(5), 1323-1330. https://doi.org/10.1016/j.athoracsur.2018.01.048
4. Sellke F.W., DiMaio J.M., Caplan L.R., et al. (2005). Comparing On-Pump and Off-Pump Coronary Artery Bypass Grafting: Numerous Studies but Few Conclusions: A Scientific Statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia in collaboration with the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation, 111, 2858-2864. https://doi.org/10.1161/CIRCULATIONAHA.105.165030
5. Alexander J.H., Hafley G., Harrington R.A., et al. (2011). Efficacy and safety of repeat revascularization in elderly patients with coronary artery disease: Insights from the SYNTAX trial. American Heart Journal, 162(4), 709-718. https://doi.org/10.1016/j.ahj.2011.07.019
Keywords
1. Coronary Artery Bypass Grafting Outcomes
2. Off-Pump vs On-Pump CABG
3. Elderly Cardiac Surgery
4. CABG in Octogenarians
5. Postoperative Complications CABG
The study’s DOI and references provide a pathway for practitioners and researchers to further explore the considerations necessary for effectively managing and treating the octogenarian patient population undergoing coronary artery procedures. With the evolution of surgical techniques and the advent of new medical technology, it is imperative that the medical community remains vigilant in evaluating the most favorable approaches to CABG for elderly patients, ensuring the enhancement of postoperative outcomes and overall quality of life.