Abstract
Early ambulation after cardiovascular operations has been recommended, especially for octogenarians. Recently, it is suggested that early weaning from the ventilator enables octogenarians to ambulate earlier. Therefore when we underwent isolated off-pump coronary artery bypass (OPCAB) operations, we tried to extubate immediately after the operations were finished in the operating room. We compared the clinical outcome of “immediate extubation” after OPCAB between octogenarians and younger patients. From January 2006 to December 2010, 107 patients underwent isolated OPCAB. We defined group A as octogenarians (n=28; 82.5±0.4 years old) and group B as younger patients (n=79; 69.3±0.8 years old). “Immediate extubation” was defined as wakening and extubating in operation room as soon as the operation was finished. Contraindications to “immediate extubation” were hemodynamic instability and moderate chest tube drainage of blood at the end of operation. There were significant differences between group A and B in terms of the following preoperative factors; moderate or severe mitral valve regurgitation (MR) (46.4% vs 21.5%; P<0.05), chronic renal failure (CRF) (32.1% vs 11.4%; P<0.05) and poor left ventricular function (37.5% vs 14.8%; P<0.05), whereas no statistical difference was acknowledged in any intraoperative factor such as operative time, the number of grafts, the use of IABP and emergency status. Rate of immediate extubation (53.6% vs. 79.5%; P<0.05), length of ICU stay (7.4±1.7 vs 2.8±0.3 days, P<0.001) and numbers of in-hospital deaths (21.4% vs 0%, P<0.001) were significantly worse in group A. However, octogenarians who were succeeded in immediate extubation could reduce the length of ICU stay and hospital stay. We further need to investigate the relationship between pre- and postoperative factors and early ambulation.
