Short-term and long-term outcomes of octogenarians after off-pump coronary artery bypass surgery.
OBJECTIVE
Off-pump coronary artery bypass has been reported to be associated with reduced morbidity and mortality after surgical coronary revascularization, especially in high-risk patients. The aim of this study was to clarify the efficacy of off-pump coronary artery bypass for the very elderly patients.


METHODS
We compared the outcomes of octogenarians (n = 28, 82 ± 2 years) undergoing off-pump coronary artery bypass and those of the patients <80 years of age (n = 315, 67 ± 9 years) during short- and long-term periods.


RESULTS
There was no difference in hospital mortality between octogenarians and the younger cohort (3.8% vs. 0.6%; P = 0.11). A high rate of postoperative complications (e.g., pneumonia, transient renal dysfunction, ventricular arrhythmia) were observed in the octogenarians. The long-term survival (81% at 5 years) and the rate of freedom from cardiac death (92% at 5 years) and from cardiac events (85% at 5 years) were excellent in the octogenarians; they appeared less favorable, however, when compared with the younger group (95%, 98%, and 94% at 5 years, respectively). Most of the cardiac adverse events, including unexplained sudden death, occurred 6 months after the surgery in octogenarians.


CONCLUSIONS
Off-pump coronary artery bypass can be performed safely in octogenarians, with excellent early and late outcomes. Careful postoperative follow-up is required to reduce postoperative long-term adverse events. Off-pump coronary artery bypass is a feasible modality of coronary revascularization for octogenarians.
Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Shinya
S
Takase
Hitoshi
H
Yokoyama
Hirono
H
Satokawa
Yoshiyuki
Y
Sato
Hiroyuki
H
Kurosawa
Yuki
Y
Seto
Akihito
A
Kagoshima
Takashi
T
Igarashi
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome