title: Comparison of the Safety and Efficacy of On-Pump (ONCAB) versus Off-Pump (OPCAB) Coronary Artery Bypass Graft Surgery in the Elderly: A Review of the ANZSCTS Database.
abstract: BACKGROUND
  The elderly population (age >70 years) incurs greater mortality and morbidity following CABG. Off-pump coronary artery bypass (OPCAB) may mitigate these outcomes. A retrospective analysis of the results of OPCAB in this population was performed.
  
  
  METHODS
  We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for elderly patients (n=12697) undergoing isolated CABG surgery and compared the on-pump coronary artery bypass (ONCAB) (n=11676) with OPCAB (n=1021) technique. Preoperative and intraoperative risk factors, and postoperative outcomes were analysed. Survival analyses was performed after cross-matching the database with the national death registry to identify long-term mortality.
  
  
  RESULTS
  High-risk patients were more prevalent in the ONCAB group (p<0.05). OPCAB patients received fewer distal anastomoses than ONCAB patients (2.4±1.1 vs 3.3±1.0, p<0.001). Thirty-day mortality and stroke rates between OPCAB and ONCAB were not significantly different (2% vs 2.5% and 1.1% vs 1.8%, respectively). There was a non-significant trend towards improved 10-year survival in OPCAB patients using multivariate analysis (78.8% vs. 73.3%, p=0.076, HR 0.83; 95% CI 0.67-1.02).
  
  
  CONCLUSIONS
  Mortality and stroke rates following CABG surgery are extremely low in the elderly suggesting that surgery is a safe management option for coronary artery disease in this population. OPCAB did not offer a significant advantage over ONCAB with regards to 30-day mortality, stroke and long-term survival. Further prospective randomised trials will be necessary to clarify risks or benefits in the elderly.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia. Electronic address: vikrantdhurandhar@hotmail.com.
authors.forename: Vikrant
authors.initials: V
authors.lastname: Dhurandhar
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Roneil
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.affiliation: Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Jennifer Kay
authors.initials: JK
authors.lastname: Butcher
authors.affiliation: Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Deborah Ann
authors.initials: DA
authors.lastname: Black
authors.affiliation: CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic., Australia.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Tran
authors.affiliation: CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic., Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: Coronary artery bypass graft; Elderly; High risk; Off-pump; On-pump