Early outcomes of two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONG Tao , ZHANG Qi , LIU Honghao , YAO Xingxing , JIAO Zhouyang ,  LIU Chao

Department of Cardiac Surgery, Zhengzhou University, Zhengzhou, 450052, P.R.China;

Corresponding author：

LIU Chao, Email: Liubeilun@sohu.com

Keywords：

Two-stage Hybrid surgery; traditional thoracotomy surgery; elderly patients

DOI：

10.7507/1007-4848.201609028

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05). Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.

Citation： SONG Tao, ZHANG Qi, LIU Honghao, YAO Xingxing, JIAO Zhouyang, LIU Chao. Early outcomes of two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(10): 783-786. doi: 10.7507/1007-4848.201609028 Copy

1.	Kamiya H, Tanzeem N, Akhyari P, et al. Impact of severe postoperative complications after cardiac surgery on mortality in patients aged over 80 years. Thorac Cardiovasc Surg, 2012, 60(5): 343-350.
2.	蔡红雁. Hybrid 技术治疗复杂冠心病进展. 心血管病学进展, 2008, 29(1): 84.0.
3.	王进, 肖锋, 李岩, 等. 单中心 1098 例冠状动脉旁路移植术围手术期危险因素分析. 北京大学学报(医学版), 2011, 43(1): 134-139.0.
4.	Parsionnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation, 1989, 79(6): I3-I12.
5.	Nashef SAM, Roques F, Michael P, et al. European system for cardiac operative risk evaluation (EUROSCORE). Eur J Cardiovasc Surg, 1999, 16(1): 9-13.
6.	Boques F, Nashef SAM, Michael P, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg, 1999, 15(6): 816-823.
7.	Nissinen J, Wistbacka JO, Loponen P, et al. Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected. Ann Thorac Surg, 2010, 89(4): 1119-1124.
8.	Serrao M, Graca F, Rodrigues R, et al. Coronary artery bypass grafting in octogenarians: long-term results. Rev Port Cardiol, 2010, 29(6): 989-998.
9.	武忠, 王东进, 张杰. 80 岁以上高龄患者冠状动脉旁路移植术的临床处理. 实用医学杂志, 2009, 25(19): 3263-3264.0.
10.	Stamou SC, Dangas G, Dullum MKC, et al. Beating heart surgery in Octogenarians: perioperative outcome and comparison with younger age Groups. Ann Thorac Surg, 2000, 69(4): 1140-1145.
11.	Mckellar SH, Brown ML, Frye RL, et al. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. Nat Clin Pract Cardiovasc Med, 2008, 5(11):738-746.
12.	Vasques F, Rainio A, Heikkinen J, et al. Off-pump versus on-pumpcoronary artery bypass surgery in patients aged 80 years and older: institutional results and meta-analysis. Heart Vessels, 2013, 28(1): 46-56.
13.	Wrigley BJ, Dubey G, Spyt T, et al. Hybrid revasculariscation in multivessel coronary artery disease: could a combination of CABG and PCI be the best option in selected patients. EuroIntervention, 2013, 8(11): 1335-1341.
14.	Balacumaraswami L, Taggart DP. Intraoperative imaging techniques to assess coronary artery bypass graft patency. Ann Thorac Surg, 2007, 83(6): 2251-2257.
15.	Puskas JD, Williams WH, Mahoney EM, et al. Off-pump vs. conventional coronary artery bypass grafting: Early and 1-year graft patency, cost, and quality-of-life outcomes: A randomized trial. JAMA, 2004, 291(15): 1841-1849.
16.	Benetti FJ, Ballester C, Sani G, et al. Video assisted coronary bypass surgery. J Card Surg, 1995, 10(6): 620-625.
17.	Rogers CA, Pike K, Angelini CD, et al. An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomv on morbidity and health care resource use in patients having off—pump coronary artery bypass surgery: the Sternotomy Versus Thoracotomy (STET) trial. J Thorac Cardiovase Surg, 2013, 146(2): 306-316.
18.	Phan K, Wong S, Wang N, et al. Hybrid coronary revascularization versus coronary artery bypass surgery: systemic review and meta-analysis. Int J Cardiol, 2015, 179(1): 484-488.
19.	Harskamp RE, Bagai A, Halkos ME, et al. Clinical outcomes after Hybrid coronary revascularization versus coronary artery bypass surgery: A meta-analysis of 1,190 patients. Am Heart J, 2014, 167(4):585-592.
20.	许李力, 尤斌, 李平, 等. 微创直视旁路移植术与 PCI 杂交手术早中期随访. 中华胸心血管外科, 2015,31(12): 752-754.0.
21.	Raja SG, Shah J, Vavaratnarajah M, et al. Outcomes and predictors of mortality and stroke after on-pump and off-pump coronary artery bypass surgery in octogenarians. Innovations (Phila), 2013, 8(4): 269-275.

1. Kamiya H, Tanzeem N, Akhyari P, et al. Impact of severe postoperative complications after cardiac surgery on mortality in patients aged over 80 years. Thorac Cardiovasc Surg, 2012, 60(5): 343-350.
2. 蔡红雁. Hybrid 技术治疗复杂冠心病进展. 心血管病学进展, 2008, 29(1): 84.0.
3. 王进, 肖锋, 李岩, 等. 单中心 1098 例冠状动脉旁路移植术围手术期危险因素分析. 北京大学学报(医学版), 2011, 43(1): 134-139.0.
4. Parsionnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation, 1989, 79(6): I3-I12.
5. Nashef SAM, Roques F, Michael P, et al. European system for cardiac operative risk evaluation (EUROSCORE). Eur J Cardiovasc Surg, 1999, 16(1): 9-13.
6. Boques F, Nashef SAM, Michael P, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg, 1999, 15(6): 816-823.
7. Nissinen J, Wistbacka JO, Loponen P, et al. Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected. Ann Thorac Surg, 2010, 89(4): 1119-1124.
8. Serrao M, Graca F, Rodrigues R, et al. Coronary artery bypass grafting in octogenarians: long-term results. Rev Port Cardiol, 2010, 29(6): 989-998.
9. 武忠, 王东进, 张杰. 80 岁以上高龄患者冠状动脉旁路移植术的临床处理. 实用医学杂志, 2009, 25(19): 3263-3264.0.
10. Stamou SC, Dangas G, Dullum MKC, et al. Beating heart surgery in Octogenarians: perioperative outcome and comparison with younger age Groups. Ann Thorac Surg, 2000, 69(4): 1140-1145.
11. Mckellar SH, Brown ML, Frye RL, et al. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. Nat Clin Pract Cardiovasc Med, 2008, 5(11):738-746.
12. Vasques F, Rainio A, Heikkinen J, et al. Off-pump versus on-pumpcoronary artery bypass surgery in patients aged 80 years and older: institutional results and meta-analysis. Heart Vessels, 2013, 28(1): 46-56.
13. Wrigley BJ, Dubey G, Spyt T, et al. Hybrid revasculariscation in multivessel coronary artery disease: could a combination of CABG and PCI be the best option in selected patients. EuroIntervention, 2013, 8(11): 1335-1341.
14. Balacumaraswami L, Taggart DP. Intraoperative imaging techniques to assess coronary artery bypass graft patency. Ann Thorac Surg, 2007, 83(6): 2251-2257.
15. Puskas JD, Williams WH, Mahoney EM, et al. Off-pump vs. conventional coronary artery bypass grafting: Early and 1-year graft patency, cost, and quality-of-life outcomes: A randomized trial. JAMA, 2004, 291(15): 1841-1849.
16. Benetti FJ, Ballester C, Sani G, et al. Video assisted coronary bypass surgery. J Card Surg, 1995, 10(6): 620-625.
17. Rogers CA, Pike K, Angelini CD, et al. An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomv on morbidity and health care resource use in patients having off—pump coronary artery bypass surgery: the Sternotomy Versus Thoracotomy (STET) trial. J Thorac Cardiovase Surg, 2013, 146(2): 306-316.
18. Phan K, Wong S, Wang N, et al. Hybrid coronary revascularization versus coronary artery bypass surgery: systemic review and meta-analysis. Int J Cardiol, 2015, 179(1): 484-488.
19. Harskamp RE, Bagai A, Halkos ME, et al. Clinical outcomes after Hybrid coronary revascularization versus coronary artery bypass surgery: A meta-analysis of 1,190 patients. Am Heart J, 2014, 167(4):585-592.
20. 许李力, 尤斌, 李平, 等. 微创直视旁路移植术与 PCI 杂交手术早中期随访. 中华胸心血管外科, 2015,31(12): 752-754.0.
21. Raja SG, Shah J, Vavaratnarajah M, et al. Outcomes and predictors of mortality and stroke after on-pump and off-pump coronary artery bypass surgery in octogenarians. Innovations (Phila), 2013, 8(4): 269-275.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early outcomes of two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease

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