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Ann Thorac Surg 2000;69:1471-1475
© 2000 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery and the Center for Minimally Invasive Cardiac Surgery, The Buffalo General Hospital, SUNY at Buffalo, Buffalo, New York, USA
Address reprint requests to Dr Karamanoukian, Division of Cardiothoracic Surgery, The Buffalo General Hospital, 100 High St, Buffalo, NY 14203
e-mail: lisbon5{at}yahoo.com
Background. Myocardial revascularization in elderly patients is associated with a morbidity and a mortality substantially higher than those observed in younger patients. The aim of this study was to analyze the potential benefits of coronary artery bypass grafting without cardiopulmonary bypass (CPB) for octogenarians.
Methods. Of 269 octogenarians who underwent coronary artery bypass grafting at our institution between January 1995 and May 1999, 172 had the operation with CPB (CPB group) and 97, without CPB (off-pump group). Revascularization of the circumflex system or right coronary artery were not considered contraindications to off-pump grafting. Demographic data, preoperative risk factors, comorbid conditions, angiographic findings, postoperative complications, and outcomes were compared.
Results. The groups were comparable for age, sex, Canadian Cardiovascular Society class, operative priority (elective, urgent, or emergent), preoperative risk factors, and left ventricular ejection fraction. A significantly higher proportion of reoperations was observed in the off-pump cohort (16 of 97, 16.5%) compared with the CPB cohort (8 of 172, 4.7%) (p = 0.002). There was a trend toward a higher graft-patient ratio in the CPB group (3.3 versus 1.8; p = not significant). Freedom from postoperative complications was significantly higher in the off-pump group than in the CPB group (83 of 97, 85.6%, versus 129 of 172, 75%; p = 0.04). The incidence of stroke was 0% in the off-pump cohort compared with 9.3% (16 of 172) in the CPB cohort (p < 0.0005). Although there was a trend toward higher 30-day and risk-adjusted mortality rates in the off-pump group than in the CPB group (10.3% versus 5.2% and 2.8% versus 1.8%, respectively), the differences were not significant. The length of hospitalization was slightly lower in the off-pump group (9.1 versus 10.8 days; p = not significant).
Conclusions. This investigation suggests that patients 80 years of age and older undergoing off-pump coronary artery bypass grafting can experience significantly lower rates of perioperative stroke and overall complications compared with those undergoing the same procedure with CPB, although a trend toward higher mortality rates was observed in the off-pump group.
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 D. Van Dijk, E. W. L. Jansen, R. Hijman, A. P. Nierich, J. C. Diephuis, K. G. M. Moons, J. R. Lahpor, C. Borst, A. M. A. Keizer, H. M. Nathoe, et al. Cognitive Outcome After Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Trial JAMA, March 20, 2002; 287(11): 1405 - 1412. [Abstract] [Full Text] [PDF]
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H. L. Karamanoukian, H. W. Donias, and J. Bergsland Decreased incidence of postoperative stroke following off-pump coronary artery bypass J. Am. Coll. Cardiol., March 6, 2002; 39(5): 917 - 917. [Full Text] [PDF]
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P. Menasche The systemic factor: the comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery Ann. Thorac. Surg., December 1, 2001; 72(6): S2260 - 2265. [Abstract] [Full Text] [PDF]
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M. Capdeville and J. H. Lee Off-Pump Coronary Artery Bypass Surgery: Revival of an Old Technique Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 345 - 361. [Abstract] [PDF]
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P. Demers and R. Cartier Multivessel off-pump coronary artery bypass surgery in the elderly Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 908 - 912. [Abstract] [Full Text] [PDF]
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C. Schmitz and E. H. Blackstone International Council of Emboli Management (ICEM) Study Group results: risk adjusted outcomes in intraaortic filtration Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 986 - 991. [Abstract] [Full Text] [PDF]
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J. M. Murkin Attenuation of neurologic injury during cardiac surgery Ann. Thorac. Surg., November 1, 2001; 72(5): S1838 - 1844. [Abstract] [Full Text] [PDF]
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A. M. Calafiore, M. Di Mauro, M. Contini, G. Di Giammarco, M. Pano, G. Vitolla, A. Bivona, R. Carella, and S. D'Alessandro Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease: impact of the strategy on early outcome Ann. Thorac. Surg., August 1, 2001; 72(2): 456 - 462. [Abstract] [Full Text] [PDF]
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S. C. Stamou and P. J. Corso Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future Ann. Thorac. Surg., March 1, 2001; 71(3): 1056 - 1061. [Abstract] [Full Text] [PDF]
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