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

Background. Octogenarians have higher morbidity and mortality rates (90% to 16%) after coronary artery bypass grafting with cardiopulmonary bypass, co mpared with younger patients. Methods. We compared the perioperative outcome and hospital stay after coro nary artery bypass grafting without cardiopulmonary bypass (off-pump) from January 1987 to May 1999, among patients older than 80 years (n = 71), pati ents 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 octogen arians 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 infar ction 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 octo genarians compared with younger groups included pneumonia (6% in octogenari ans 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%, r espectively, 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-hospita l mortality rate was higher in octogenarians (6% versus 3% for 70 to 79 yea r-olds and 0.3% for 60 to 69 year-olds, p = 0.006). Conclusions. When appropriately applied in patients older than 80 years, of f-pump coronary artery bypass grafting can be done with acceptable postoper ative morbidity, mortality, and hospital stay. (C) 2000 by The Society of T horacic Surgeons.