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Comparative Study
. 2020 Sep 10;15(9):e0238880.
doi: 10.1371/journal.pone.0238880. eCollection 2020.

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

Piotr Knapik  1 , Grzegorz Hirnle  2 , Anetta Kowalczuk-Wieteska  2 , Michał O Zembala  2 , Szymon Pawlak  2 , Tomasz Hrapkowicz  2 , Piotr Przybyłowski  3   4 , Paweł Nadziakiewicz  1 , Daniel Cieśla  5 , Bartłomiej Perek  6 , Bogusław Kapelak  7 , Marek Cisowski  8 , Jan Rogowski  9 , Edward Pietrzyk  10 , Zdzisław Tobota  11 , Marian Zembala  2 ; KROK Investigators
Affiliations
Comparative Study

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

Piotr Knapik et al. PLoS One. .

Abstract

Background: According to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians.

Objectives: The aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data.

Methods: All octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery.

Results: Octogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013).

Conclusion: On the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patients’ flow through the study.
Fig 2
Fig 2. All coronary artery surgery procedures in Poland over a period of 11 years (2006–2016) and the amount of octogenarians in this population.
Fig 3
Fig 3. Kaplan-Meier curves for octogenarians remaining ventilated following CABG and OPCAB in a propensity-matched patients.
Fig 4
Fig 4
Probability of survival in octogenarians undergoing CABG and OPCAB surviving hospital stay: (A)–all patients, (B)–propensity-matched patients.
See this image and copyright information in PMC

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