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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Coronary artery bypass surgery in the elderly: A comparison of minimized and conventional extracorporeal circulation

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  • Miriam Freundt - Saint Josef Hospital, Internal Medicine, Denver, CO 80216, USA
  • Assad Haneya - Universitätsklinikum Regensburg, Herz-und Thoraxchirurgie, Regensburg, Deutschland
  • Stephan Hirt - Universitätsklinikum Regensburg, Herz-und Thoraxchirurgie, Regensburg, Deutschland
  • Christof Schmid - Universitätsklinikum Regensburg, Herz-und Thoraxchirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch580

doi: 10.3205/15dgch580, urn:nbn:de:0183-15dgch5809

Published: April 24, 2015

© 2015 Freundt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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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.