Original article: cardiovascular
Multivessel off-pump revascularization in octogenarians: early and midterm outcomes

https://doi.org/10.1016/S0003-4975(03)00014-6Get rights and content

Abstract

Background

Octogenarians are increasingly being referred for coronary artery revascularization. However, the prevalence of comorbid events and the propensity for neurologic dysfunction place octogenarians at higher risk for cardiopulmonary bypass–induced morbidity and mortality. Therefore, octogenarian patients represent a particularly attractive target for application of off-pump coronary artery bypass grafting.

Methods

From January 1999 to August 2001, 113 octogenarians had off-pump coronary artery bypass grafting. Their data were prospectively entered into the cardiac surgery database and analyzed retrospectively. Follow-up information was obtained through telephone survey.

Results

The mean age of the patients was 83 ± 2.5 years, and the mean number of grafts per patient was 3.3 ± 1. The most prevalent postoperative complication was atrial fibrillation (43%). Postoperative neurologic complications were seen in 5 patients (4%). There was one postoperative death (30-day mortality rate, 0.9%). The mean follow-up was 13.2 ± 7 months and was complete for 90% of the patients. At the time of telephone survey, 85 (87%) of 98 patients were free from angina, and 91 (88%) were free from cardiac-related readmission. There were three late deaths. The majority of octogenarians (66%) reported that in retrospect, they would have the operation again.

Conclusions

Off-pump multivessel revascularization in octogenarians is associated with excellent early and intermediate outcomes and provides a satisfactory quality of life.

Section snippets

Patient group

Our prospectively (daily) updated database (CAOS; Intelligent Business Solutions, Clemmons, NC) was queried to identify all patients who underwent CABG at Newark Beth Israel Medical Center and Saint Barnabas Hospital between January 1, 1999, and July 31, 2001. A total of 1,624 were found. Of these, 911 (56%) had OPCAB procedures, and 113 of them were octogenarians. The latter represents our study group. Of note, during this period, 29 octogenarians underwent traditional CABG.

Demographics,

Results

One hundred thirteen consecutive octogenarians underwent OPCAB during the study period. The demographic profile and the clinical characteristics are shown in Table 1. Mean age was 83 ± 2.5 years. The majority (81%) of patients had a history of hypertension. Previous myocardial infarction, tobacco use, diabetes, and congestive heart failure were also prevalent comorbid conditions. The mean left ventricular ejection fraction was 0.51 ± 0.11, and 11% of patients had a history of a previous

Comment

The explosive growth of OPCAB parallels the growth of the referral of elderly patients for revascularization. Most of the literature, however, addresses the use of OPCAB in younger patients with lower risk profiles, thus highlighting the trend to exclude this older population of patients when considering newer technologies. As the learning curve with OPCAB has been overcome and technical skill with the procedure has been enhanced, many investigators, including our group, believe that the

Acknowledgements

We gratefully acknowledge Gladys Belarmino, RN, and Therese Evangelista, RN, for their indispensable assistance with maintenance of the CAOS database.

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