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Sotiris C. Stamou
Mercedes K.C. Dullum
Albert J. Pfister
Steven W. Boyce
Ammar S. Bafi
Jorge M. Garcia
Paul J. Corso
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Ann Thorac Surg 2000;69:1140-1145
© 2000 The Society of Thoracic Surgeons

ORIGINAL ARTICLES: CARDIOVASCULAR

Beating heart surgery in octogenarians: perioperative outcome and comparison with younger age groups

Sotiris C. Stamou, MDa, George Dangas, MDa, Mercedes K.C. Dullum, MDa, Albert J. Pfister, MDa, Steven W. Boyce, MDa, Ammar S. Bafi, MDa, Jorge M. Garcia, MDa, Paul J. Corso, MDa

a Division of Cardiac Surgery, Department of Surgery, Washington Hospital Center; MedStar Research Institute, Washington, DC, USA

Address reprint requests to Dr Corso, Washington Hospital Center, 106 Irving St NW, Suite 316 South Tower, Washington, DC 20010
e-mail: pjc{at}mhg.edu

Background. Octogenarians have higher morbidity and mortality rates (9% to 16%) after coronary artery bypass grafting with cardiopulmonary bypass, compared with younger patients.

Methods. We compared the perioperative outcome and hospital stay after coronary artery bypass grafting without cardiopulmonary bypass (off-pump) from January 1987 to May 1999, among patients older than 80 years (n = 71), patients between 70 and 79 years (n = 228), and patients whose age ranged from 60 to 69 years (n = 296). In comparison with younger patients, more octogenarians were female (51% versus 39% in patients aged 70 to 79 years and 35% in those aged 60 to 69 years, p = 0.04), they had previous myocardial infarction more frequently (48% versus 47% versus 34%, respectively, p = 0.008), and were operated on urgently (69% versus 56% versus 52%, respectively, p = 0.04).

Results. Postoperative complications that were significantly higher in octogenarians compared with younger groups included pneumonia (6% in octogenarians versus 2% in patients aged 70 to 79 years and 0% in patients aged 60 to 69 years, p = 0.001) and atrial fibrillation (47% versus 32% versus 21%, respectively, p < 0.001). By multivariate logistic regression analysis, age over 80 years was an independent predictor of prolonged hospital stay (odds ratio = 2.7, 95% confidence interval, 1.4 to 5, p < 0.001). The in-hospital mortality rate was higher in octogenarians (6% versus 3% for 70 to 79 year-olds and 0.3% for 60 to 69 year-olds, p = 0.006).

Conclusions. When appropriately applied in patients older than 80 years, off-pump coronary artery bypass grafting can be done with acceptable postoperative morbidity, mortality, and hospital stay.




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