Off-pump versus on-pump coronary artery bypass grafting in elderly patients at 30 days: a propensity score matching study

Background Elderly patients are at increased risk of perioperative morbidity and mortality after conventional on-pump coronary artery bypass grafting (ONCABG). This study was to determine whether such high-risk population would benefit from off-pump coronary artery bypass grafting (OPCABG).Methods A retrospective analysis was performed on patients aged 65 years or older who underwent isolated coronary artery bypass grafting for the first time in Wuhan Union Hospital from January 2015 to January 2021. We used propensity score matching to adjust for differences in baseline characteristics between the ONCABG and OPCABG groups. Morbidity and mortality within 30 days after surgery were compared between the two groups. All operations were performed by experienced cardiac surgeons.Results A total of 511 patients (ONCABG 202, OPCABG 309) were included. After 1:1 matching, the baseline characteristics of the two groups were comparable (ONCABG 173, OPCABG 173). The OPCABG group had higher rate of incomplete revascularization (13.9% vs. 6.9%; P = .035) than the ONCABG group. However, OPCABG reduced the risk of postoperative renal insufficiency (15.0% vs. 30.1%; P = .001) and reoperation for bleeding (0.0% vs. 3.5%; P = .030). There were no significant differences in early postoperative mortality, myocardial infarction, stroke, and other outcomes between the two groups.Conclusions OPCABG is an alternative revascularization method for elderly patients. It reduces the risk of early postoperative renal insufficiency and reoperation for bleeding. What is already known on this topic Elderly patients are at increased risk of perioperative morbidity and mortality after conventional on-pump coronary artery bypass grafting. What this study adds Off-pump coronary artery bypass grafting reduced the risk of early postoperative renal insufficiency and reoperation for bleeding in elderly patients. How this study might affect research, practice or policy The study showed that off-pump coronary artery bypass grafting is an alternative surgical method for revascularization in elderly patients with coronary heart disease. It can provide data support for clinicians to select off-pump procedure for elderly patients and facilitate clinical decision-making, outcome assessment, and quality improvement.