Perioperative outcome after off-pump coronary artery bypass or beating heart surgery in octogenarians

Objectives: Coronary artery bypass graft (CABG) in octogenarians is performed more and more frequently, although the operation technique of best benefit is unknown. The aim of this retrospective study was to compare the results of CABG in octogenarians using beating heart technique on cardiopulmonary bypass or off-pump coronary artery bypass surgery (OPCAB).

Methods: 166 patients over 80 years undergoing CABG from January 1999 to December 2005 were identified and compared between the group I undergoing OPCAB (76) and the group II undergoing beating heart CABG (90). Mean follow up was 3 ± 1 year. χ₂-Test, fisher's exact test and Student's -t-test were performed, p-value < 0.05 was considered to be statistically significant.

Results: There were no significant differences between the two groups in the preoperative risk profile. The mean number of distal anastomosis overall was 3.75. The ICU time was significantly longer in group II (99.8h vs. 54.5h = p < 0.05) as well as the intubation time (32.7h vs. 16.4h = p < 0.05). The need for transfusion and blood plates was significantly higher in group II (p < 0.05). There was no significant difference in postoperative renal failure (8% vs. 3%) and catheter interventions (11.5% vs. 7%). We had one neurologic event in group I and no neurological complications in group II. The significance of 30 day mortality (12.2% vs. 4%) was with p = 0.051 on the limit. The long time survival was significant higher in group I (p = 0.03).

Fig. 1: Beating Heart (1) vs. Off Pump (2), p-Wert 0.03

Conclusion: This retrospective study suggests a benefit of OPCAB in terms of perioperative transfusions, ICU time, intubation time and long term survival. Operative mortality and neurological complication was similar in both groups.