Off-Pump versus On-Pump Coronary Artery Bypass Grafting in Octogenarians: Comparison of Short-Term Outcomes and Long-Term Survival

Off-pump coronary artery bypass (OPCAB) has gained increasing acceptance with potential benefits for high-risk elderly patients. We report a surgeon's operative outcomes in octogenarians with an OPCAB program. Retrospective, intention-to-treat analysis of 97 consecutive octogenarians who underwent coronary bypass by a single surgeon between 1997 and 2001 before and after initiation of a multivessel OPCAB program was performed. OPCAB was attempted in all octogenarians. The OPCAB cohort had higher serum creatinine (OPCAB vs. pre-OPCAB: 1.30 +/- 0.79 mg/dl vs. 1.08 +/- 0.27, p = 0.04) and ejection fractions (52 +/- 14% vs. 45 +/- 11%, p = 0.02) than the pre-OPCAB cohort. The OPCAB group was more likely to require urgent/emergency surgery (63 vs. 40%, p = 0.04) and to have chronic renal insufficiency (18 vs. 3%, p = 0.05). After programmatic change to OPCAB, significant postoperative improvements were observed in the length of hospital stay (17 +/- 19 vs. 8 +/- 4 days, p < 0.01), duration of inotropic requirement (47 +/- 70 vs. 18 +/- 39 h, p < 0.04), duration of ventilator support (51 +/- 54 vs. 16 +/- 27 h, p < 0.01) and incidence of tracheostomy (16 vs. 3%, p < 0.02). In-hospital mortalities (3.2 vs. 2.7%), strokes (3 per group) and 5-year survival did not differ significantly (57 vs. 67%, p = 0.50, NS). Despite some higher preoperative risks, the OPCAB program demonstrated clinical benefits in octogenarians but no advantage in hospital-mortality or long-term survival. Copyright (C) 2013 S. Karger AG, Basel