Multivessel off-pump coronary artery bypass surgery in the elderly

Objective: Coronary artery bypass grafting in the elderly patient is associ ated with increased perioperative morbidity and mortality. The avoidance of cardiopulmonary bypass (CPB) in this population is potentially beneficial. We examined our initial experience with off-pump multivessel coronary arte ry revascularization in patients aged 70 years and older. Methods: In a con secutive series of 300 off-pump coronary artery bypass (OPCAB) operations p erformed by a single surgeon between 1996 and 1999, 98 patients were aged 7 0 years and older. These patients were compared with a consecutive cohort o f 497 patients aged 70 years and older operated on with CPB in the same ins titution from 1995 to 1996, period where OPCAB surgery was not performed in our institution. Results: Patients in the beating heart group were older ( 75 +/- 4 vs. 74 +/- 3 years; P = 0.001). Gender distribution and other preo perative risk factors were comparable for the two groups. On average, 3.0 /- 0.8 and 2.8 +/- 0.7 grafts per patient were completed in the OPCAB and t he CPB groups, respectively (P = 0.007). Perioperative mortality rates (OPC AB group, 3.1%; CPB group, 3.6%), perioperative myocardial infarction (OPCA B, 2.0%; CPB, 5.1%) and neurologic events (OPCAB, 1.0%; CPB, 3.2%) were com parable for the two groups. The incidence of postoperative atrial fibrillat ion was lower in the OPCAB group (42 vs. 54%; P = 0.05). The need for allog enic blood transfusions was significantly less in the OPCAB group (53 vs. 8 2%; P = 0.001). Conclusions: In patients aged 70 years and older, multivess el OPCAB surgery is associated with lower rates of postoperative atrial fib rillation and reduced transfusion requirements. Multivessel OPCAB in the el derly patient is an acceptable alternative to procedures performed with CPB . (C) 2001 Published by Elsevier Science B.V.