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(Circulation. 2002;106:I-5.)
© 2002 American Heart Association, Inc.

Surgery for Coronary Heart Disease

Reduced Mortality and Strokes With Off-Pump Coronary Artery Bypass Grafting Surgery in Octogenarians

Roland G. Demaria, MD; Michel Carrier, MD; Simon Fortier, MD; Raymond Martineau, MD; Annick Fortier, MSc; Raymond Cartier, MD; Michel Pellerin, MD; Yves Hébert, MD; Denis Bouchard, MD; Pierre Pagé, MD; Louis P. Perrault, MD, PhD

From the Research Center and Departments of Surgery (R.G.D., S.F., R.C., M.P., Y.H., D.B., P.P., M.C., L.P.P.), Anesthesiology (R.M.), and Biostatistics (A.F.), Montreal Heart Institute, Montreal, Quebec, Canada, and the Cardiovascular Surgery Unit, Arnaud de Villeneuve Teaching Hospital, Montpellier, France (R.G.D.).

Correspondence to Louis P. Perrault, MD, PhD, Research Center, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada. E-mail lpperrau{at}icm.umontreal.ca

Background Off-pump coronary artery bypass surgery (OPCAB) has been revived and has gained popularity, although the exact subsets of patients who might benefit most from this technique are unknown. The aim of this retrospective study was to compare the results of coronary artery bypass grafting surgery (CABG) in octogenarians using cardiopulmonary bypass (CPB) or OPCAB techniques.

Methods and Results Over a 5-year period (1995–1999), 125 patients older than 80 years of age were operated for isolated myocardial revascularization (63 using CPB and 62 with OPCAB). There was no statistically significant difference in preoperative comorbidities between groups or in mean left ventricular ejection fraction (54.5±15.3% in the CPB group and 50.9±13.5% in the OPCAB group, respectively). The mean number of distal anastomosis per patient was 2.9 in CPB group and 2.6 in OPCAB group (P=ns). The majority of patients in both groups had unstable angina and were operated on an urgent basis. The operative mortality was 15.9% in the CPB group and 4.8% in the OPCAB group (P=0.04). There were 4 postoperative strokes (6.3%) in the CPB group and none (0%) in the OPCAB group (P=0.04). The percentage of patients transfused was 92.1% in the CPB group and 72.6% in the OPCAB group (P<0.01). Postoperative myocardial infarction occurred in 11.3% in the CPB group and 14.5% in the OPCAB group (P=NS). For all the parameters entered in the multivariate analysis with logistic regression model, the type of surgery (CPB or OPCAB) was an independent predictor of operative mortality and stroke (P=0.0375). The odds ratio (OR) indicates that operative mortality and stroke occur 4 times (OR=4.171) more often in CPB patients than in OPCAB patients. Follow-up showed no significant difference between the 2 groups in terms of cardiac events and mortality.

Conclusions This retrospective study suggests a benefit of OPCAB in terms of operative mortality and stroke for octogenarian patients when compared with CPB in our institution.

Key Words: cardiopulmonary bypass • coronary disease • elderly • morbidity • mortality • surgery