The outcomes of off-pump coronary artery bypass grafting in women over 65 years

Abstract

To study survival rates and incidence of adverse effects after off-pump coronary artery bypass grafting (CABG) in women over 65 years, who are reported to have higher morbidity and mortality rates than men. METHODS: Health records were reviewed for 117 women over 65 years who underwent off-pump CABG from November 2014 to December 2022. Data were collected for demographic characteristics, pre-existing comorbidities, perioperative status, and postoperative and clinical outcomes. RESULTS: The mean (SD) age of patients was 74.4 (5.8%) years. Thirty-one (26.5%) patients were in emergent condition preoperatively. Postoperatively, 18 (15.4%) patients had atrial fibrillation. Thirty-two (27.4%) patients were extubated in the operating room. Artificial ventilation was required for 6.6 (9.3) hours, and patients remained in the cardiovascular intensive care unit for 41.6 (97.6) hours (median, 24 hours). Four patients required reexploration for bleeding (postoperative drainage, 582.5 [246.3] mL). No patients had postoperative renal failure or required dialysis, required intra-aortic balloon pump support, suffered stroke/transient ischemic attack, nor were diagnosed with postoperative myocardial infarction. Three patients (2.6%) died in the hospital, and 4 (3.4%) with obesity and diabetes had deep sternal wound infections which were treated successfully. The Kaplan-Meier 1-year survival rate was 96.5%

both the 3-year and 5-year survival rate was 95.3%. CONCLUSIONS: Older women successfully underwent off-pump CABG and total arterial revascularisation with low rates of major adverse events, mortality, and morbidity. We attribute the good long-term survival to shorter lengths of stay in both the intensive care unit and hospital and less need for blood products after off-pump CABG. ABBREVIATION: AF: atrial fibrillation, BIMA: bilateral internal mammary artery, BMI: body mass index, CABG: coronary artery bypass grafting, CAD: coronary artery disease, ICU: intensive care unit, ERAS: Enhanced Recovery After Surgery, EuroSCORE: European System for Cardiac Operative Risk Evaluation, GOPCABE: German Off-Pump Coronary Artery Bypass Grafting in the Elderly, LIMA: left internal mammary artery, NYHA: New York Heart Association, RIMA: right internal mammary artery, TIA: transient ischemic attack.