Use Of Of-Pump Coronary Artery Bypass Grafting In High-Risk Elderly Patients

Objective To compare the early postoperative outcomes of high-risk elderly coronary heart disease(CHD)patients with different coronary artery bypass grafting(CABG),to analyze the risk factors of major adverse events in the hospital,and to evaluate the advantages of off-pump coronary artery bypass grafting(OPCAB)in high-risk elderly patients.Methods We selected 560 high-risk elderly CABG patients admitted to the China Heart Surgery Registry(CCSR)from February 2013 to October 2017 according to the inclusion criteria and exclusion criteria strictly.According to the surgical method,467 cases were divided into OPCAB group(group ?)and 93 cases cases were divided into conventional coronary artery bypass grafting group(CCABG,group ?).According to whether there are major adverse events in the hospital [including reoperation,re-tracheal intubation,acute myocardial infarction(AMI),low cardiac output syndrome(LCOS),nervous system injury,new acute kidney injury(AKI),acute lung injury/Acute respiratory distress syndrome(ALI/ARDS),multiple organ injury,in-hospital death],103 cases were divided into adverse events group(group a),457 cases were divided into the control group(group b).Preoperative baseline data(such as past medical history,basic personal conditions)and surgical related data(such as surgical procedure,perioperative red blood cell transfusion,postoperative major complications)were compared between groups ? and ? and between groups a and b.Differences between groups were compared,and single factor and Logistic regression were used to analyze the risk factors of major adverse events in the hospital.Results Preoperative baseline data of the group ? was older [71(67~75)years VS.69(66~72)years,P=0.005],and serum creatinine(SCr)was higher [66(56~80)?mol/L VS.59)(53~72)?mol/L,P=0.004],left ventricle ejection fraction(LVEF)were lower[59(55~62)% VS.60(55~65)%,P=0.013],and the remaining data were not statistically different(P>0.05);in-hospital data between group ? and II in the intra-aortic balloon pump(IABP)placement rate(2.14% vs.8.28%),perioperative red blood cell transfusion volume [2(0 ~ 4)U vs 8(4~12)U],blood transfusion ratio(58.03% vs.93.55%)ventilator use time [19.0(15.5~24.0)h vs.24.5(18.0~46.5)h],AMI(0.64% vs.4.30%),LCOS(4.07% vs.21.51%),ALI/ARDS(1.07% vs.7.53%),new AKI(8.35% vs.39.78%),new-onset AF(0.64% vs.9.68%),multiple organ injury(1.93% vs.18.28%)and in-hospital mortality(1.07% vs.5.38%)were statistically significant(P<0.01),and the group ? was higher than the group ?;there was no significant difference in the number of bypass,complete revascularization rate,reoperation,and nervous system injury(P>0.05).The proportion of major adverse events in the hospital was 18.39%(103/560).There were statistical differences(P<0.05)in the preoperative application of positive inotropic drugs,LVEF values,European system for cardiac operative risk evaluation(Euro SCORE)score,perioperative red blood cell transfusion,cardiopulmonary bypass(CPB).Multivariate Logistic regression analysis showed that CPB(OR=2.577,95% CI: 1.340~4.957,P=0.005),perioperative red blood cell transfusion(OR=1.170,95% CI: 1.089~1.257,P<0.001),Preoperative LVEF values(OR=0.951,95% CI: 0.910 to 0.994,P=0.026)were risk factors for major adverse events after surgery,with CPB being an independent risk factor,among them,CPB is an independent risk factor.conclusion In high-risk elderly patients with CABG,the independent risk factor for postoperative major adverse events was CPB.The perioperative red blood cell transfusion of OPCAB was significantly lower than that of CCABG,the postoperative vital organ complications were significantly reduced,and OPCAB especially reduces the damage to the heart,lung,kidney tissue and its function.