title: Short- and long-term follow-up after minimally invasive direct coronary artery bypass in octogenarians.
abstract: Demographic changes lead to a rising incidence of octogenarians undergoing surgical revascularization of coronary artery disease. Minimally invasive direct coronary artery bypass (MIDCAB) represents a surgical treatment with reduced trauma and without the use of cardiopulmonary bypass. The aim of this study was to evaluate short- and long-term outcomes after MIDCAB in octogenarians.
  
  
  
  Between 1998 and 2012, 1060 patients underwent MIDCAB at our department. Among them, 72 patients (6.8%) were older than 80 years at the time of operation. Incidence of major adverse cardiac and cerebrovascular events (MACCEs) was compared between octogenarians [median age 82 (81; 85) years, 63.9% male] and younger MIDCAB patients [median age 64 (56; 70) years, 70.7% male] after 30 days and during follow-up. The impact of demographics and preoperative comorbidities on mortality during follow-up was analysed.
  
  
  
  At baseline, the elderly group presented with a statistically significant higher logistic EuroSCORE I (9.2 vs 2.2%, P < 0.001). Within 30 days, octogenarians showed a mortality rate of 5.6% (younger patients 0.8%, P = 0.006) and an MACCE rate of 5.6% (younger patients 1.3%, P = 0.024). The median follow-up time of 30-day survivors was 5.5 (2.9; 7.6) years and follow-up completeness reached 96.9%. In the elderly group, 1-, 3- and 5-year survival rates were 89, 78 and 63% in comparison with 97, 94 and 90% in the younger group (P < 0.001), respectively. The estimated median survival time in octogenarians was 6.7 (CI 4.854; 8.629) years. Logistic regression showed preoperative renal impairment, peripheral arterial occlusive disease and pulmonary hypertension to have a stronger impact on mortality during follow-up than age above 80 years.
  
  
  
  MIDCAB represents a safe treatment option in octogenarians and is associated with a good perioperative outcome and satisfying long-term results in octogenarians.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany grischa.hoffmann@uksh.de grischa.hoffmann@gmx.de.
authors.forename: Grischa
authors.initials: G
authors.lastname: Hoffmann
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Friedrich
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Barrabas
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Petzina
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Panholzer
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Rouven
authors.initials: R
authors.lastname: Berndt
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Coronary disease; Minimally invasive coronary artery bypass; Octogenarians