Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass

Background. Myocardial revascularization in elderly patients is associated with a morbidity and a mortality substantially higher than those observed i n younger patients. The aim of this study was to analyze the potential bene fits 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 operatio n with CPB (CPB group) and 97, without CPB (off-pump group). Revascularizat ion of the circumflex system or right coronary artery were not considered c ontraindications to off-pump grafting. Demographic data, preoperative risk factors, comorbid conditions, angiographic findings, postoperative complica tions, and outcomes were compared. Results. The groups were comparable for age, sex, Canadian Cardiovascular S ociety class, operative priority (elective, urgent, or emergent), preoperat ive risk factors, and left. ventricular ejection fraction. A significantly higher proportion of reoperations was observed in the off-pump cohort (16 o f 97, 16.5%) compared with the CPB cohort (8 of 172, 4.7%) (p = 0.002). The re was a trend toward a higher graft-patient ratio in the CPB group (3.3 Ve rsus 1.8; p = not significant). Freedom from postoperative complications wa s significantly higher in the off-pump group than in the CPB group (83 of 9 7, 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-adjust ed mortality rates in the off-pump group than in the CPB group (10.3% versu s 5.2% and 2.8% versus 1.8%, respectively), the differences were not signif icant. The length of hospitalization was slightly lower in the off-pump gro up (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 si gnificantly lower rates of perioperative stroke and overall complications c ompared with those undergoing the same procedure with CPB, although a trend toward higher mortality rates was observed in the oh-pump group. (C) 2000 by The Society of Thoracic Surgeons.