title: Anaortic off-pump coronary artery bypass grafting in the elderly and very elderly.
abstract: BACKGROUND
  Elderly patients undergoing surgical revascularisation may disproportionately benefit from avoiding manipulation of the ascending aorta and cardiopulmonary bypass. In this multi-centre observational study, we sought to determine the 30-day outcomes of anaortic off-pump coronary artery bypass (OPCAB) in an elderly and very-elderly population.
  
  
  METHODS
  Data were prospectively collected for all patients aged >70 years old (y) undergoing anaortic OPCAB at three hospitals between January 2002 and October 2011. Analysis was carried out on two age sub-groups (70-79 y vs. ≥80 y). Multiple logistic regression was used to identify predictors of post-operative 30-day mortality.
  
  
  RESULTS
  In total, 1135 patients >70 years underwent anaortic OPCAB - 817 (72%) patients were aged 70-79 y while 318 (28%) were aged ≥80 y. The rate of mortality and morbidity for both groups was low: 30-day mortality (70-79 y: 1.8%; ≥80 y: 2.8%) or permanent stroke (70-79 y: 0.2%; ≥80 y: 0.9%). Chronic lung disease, a history of previous myocardial infarction and left main disease were independent predictors of 30-day mortality.
  
  
  CONCLUSIONS
  OPCAB is associated with low rates of 30-day mortality and peri-operative stroke in this elderly and very elderly patient cohort. Anaortic OPCAB can provide excellent short-term post-operative outcomes and may give the elderly and very elderly population the opportunity to benefit from surgical coronary revascularisation.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine, The University of Sydney, Sydney, Australia; The Baird Institute for Heart and Lung Surgical Research, Sydney, Australia.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Cooper
authors.forename: J James B
authors.initials: JJ
authors.lastname: Edelman
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: R John
authors.initials: RJ
authors.lastname: Brereton
authors.forename: Donald E
authors.initials: DE
authors.lastname: Ross
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump; D018572:Disease-Free Survival; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D059035:Perioperative Period; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality; D015996:Survival Rate
keywords: Elderly; Mortality; Off-pump coronary artery bypass grafting; Stroke; Very elderly