Article
Coronary artery bypass surgery in the elderly: A comparison of minimized and conventional extracorporeal circulation
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Published: | April 24, 2015 |
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Introduction: Advanced age is an established independent risk factor for significant morbidity and mortality after coronary artery bypass grafting (CABG). Minimized extracorporeal circulation (MECC) has been shown to reduce the negative effects associated with conventional extracorporeal circulation (CECC). This trial aimed to evaluate the impact of MECC on outcome of septua- and octogenarians undergoing CABG surgery.
Material and methods: 875 patients (mean age 78.35 ± 2.95 years, 69,65% male, mean Euroscore 10,5%, 3-vessel disease 81,5%) underwent elective isolated CABG using CECC (39.4%) or MECC (60.6%) between January 2005 and December 2012. Data were analyzed retrospectively.
Results: Extracorporeal circulation time (ECT), cross-clamp time, and need for intraoperative transfusion were significantly lower (all p<0.001) using MECC. Postoperatively patients in the MECC group required less inotropic support, fewer packed red blood cell (PRBC) transfusions, temporary hemodialysis (HD) and had a lower 30-day mortality (all p<0.001). Intensive care unit (ICU) stay and duration of mechanical ventilation were significantly lower (p < 0.01) and less delirium was noted (p<0.03) after MECC. Also lactate levels were significantly lower in the MECC group (p < 0.001).
Conclusion: MECC is superior to CECC in septua- and octogenarians undergoing CABG surgery. Especially reduced ECT, 30-day mortality and lengths of ICU stay, as well as lower transfusion rates, encourage the use of MECC in elderly patients.