title: Coronary artery bypass in patients 80 years and over: is off-pump the operation of choice?
abstract: BACKGROUND
  Octogenarians are at increased risk for perioperative morbidity and mortality after coronary artery bypass. In this study we compared our experience with patients undergoing on-pump coronary artery bypass (CAB) and those undergoing off-pump coronary artery bypass (OPCAB) to assess outcomes.
  
  
  METHODS
  We used hospital database analysis in patients 80 years and older who underwent nonemergent coronary artery bypass with (N = 169) and without (N = 60) cardiopulmonary bypass from January 1999 through June 2001.
  
  
  RESULTS
  Both groups were at increased perioperative risk based on the Society of Thoracic Surgeons risk model (7.7% OPCAB vs 5.8% CAB, p = 0.03). There were no operative deaths in the OPCAB group but there were eight (4.7%) in the CAB group (p = NS). Perioperative stroke (0% OPCAB vs 7.1% CAB, p = 0.04), prolonged ventilation (1.7% OPCAB vs 11.8% CAB, p = 0.02), and transfusion rate (33% OPCAB vs 70.4% CAB, p < 0.001) were all lower in the OPCAB group. A shorter hospital stay (6.3 days OPCAB vs 11.5 days CAB, p < 0.001) resulted in lower hospital cost in the OPCAB group ($9,363 OPCAB vs $12,312 CAB, p < 0.001).
  
  
  CONCLUSIONS
  In this study, off-pump coronary artery bypass grafting in elderly patients was associated with fewer complications, a shorter hospital stay, and lower hospital cost. Off-pump coronary artery bypass grafting may be the operation of choice for octogenarians requiring surgical myocardial revascularization.
authors.affiliation: St. Thomas Heart Institute, St. Thomas Hospital, Nashville, Tennessee, USA. shoff@csapc.net
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hoff
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Ball
authors.forename: William H
authors.initials: WH
authors.lastname: Coltharp
authors.forename: David M
authors.initials: DM
authors.lastname: Glassford
authors.forename: John W
authors.initials: JW
authors.lastname: Lea
authors.forename: Michael R
authors.initials: MR
authors.lastname: Petracek
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D020521:Stroke / Q000209:etiology