Aorta no-touch off-pump coronary artery revascularization in octogenarians: 5 years' experience.
BACKGROUND
Approximately 18% of octogenarians have ischemic heart disease. Increasingly, they are being referred for coronary artery revascularization by surgical and/or percutaneous procedures. These strategies have been questioned, however, because of reports of poor outcomes in the elderly. In this study, we aimed to determine the impact of age on morbidity and mortality in patients undergoing off-pump coronary artery bypass (OPCAB) with the pi-circuit procedure during 5 years of follow-up.


METHODS
From February 2001 to November 2005, 1359 patients underwent isolated coronary revascularization with the pi-circuit technique, which consists of (1) beating heart surgery, (2) OPCAB, (3) no touching of the aorta, (4) use of composite grafts, and (5) arterial revascularization. Sixty-two patients were > or = 80 years of age (group A), and 1297 were <80 years old (group B). Both groups were compared with respect to preoperative risk factors, intraoperative parameters, and postoperative morbidity and mortality. Follow-up lasted from 4 to 60 months. Data were analyzed with the chi(2) test, the Fisher exact test, the Kaplan-Meier method, and the Cox model of regression analysis.


RESULTS
Females predominated among the octogenarians (P < .0005). Octogenarians more frequently underwent emergent operations (P < .031) and had worse ejection fractions (P < .026). Obesity was also less prevalent among these patients (P < .007). There were no differences between the groups in the preoperative and postoperative use of an intraaortic balloon pump. Octogenarians had lower cholesterol levels (P < .0005) and had fewer distal anastomoses (2.24 + or - 0.0.76 versus 2.77 + or - 0.92, P < .0005). The 2 groups were not significantly different with respect to 30-day mortality (3.2% versus 1.5%) and 7-day mortality (1.6% versus 0.2%). Differences were noted in the incidences of pulmonary complications (12.9% versus 5.6%, P < .027), atrial fibrillation (41.9% versus 19%, P < .0005), and cognitive disturbances (6.5% versus 0.3%, P < .0005). During follow-up, survival seemed to favor the younger group (P < .001). Nevertheless, further analysis of the data with the Cox regression model to exclude confounding risk factors, revealed the survival rates of the 2 groups to be similar.


CONCLUSIONS
Use of the pi-circuit technique is very effective for octogenarians. Although these older patients have a higher incidence of early postoperative morbidity, overall survival is not affected.
Prapas
Sotirios N
SN
Department of Cardiac Surgery, Henry Dunant Hospital, Mesoghion 107, Athens GR 11521, Greece. sprapas@dunanthospi.gr
Panagiotopoulos
Ioannis A
IA
Pentchev
Dimitar N
DN
Ayyad
Mohamed A Salama
MA
Protogeros
Dimitrios A
DA
Kotsis
Vasilios N
VN
Linardakis
Ioannis N
IN
Tzanavaras
Theofanis P
TP
Stratigi
Poly T
PT
D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality* / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D017678:Sex Distribution; D016019:Survival Analysis; D015996:Survival Rate; D016387:Women's Health