title: Off-pump versus on-pump coronary artery bypass grafting in octogenarians: comparison of short-term outcomes and long-term survival.
abstract: 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 multi-vessel 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.
authors.affiliation: Division of Cardiothoracic Surgery, Downstate Medical Center, State University of New York, New York, N.Y., USA. daniel.lee@downstate.edu
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Lee
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Ramirez
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Borer
authors.forename: Wilson
authors.initials: W
authors.lastname: Ko
mesh_terms: D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality*; D003324:Coronary Artery Disease / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D059035:Perioperative Period; D012189:Retrospective Studies