Off-pump technique in coronary artery bypass grafting in elderly patients.

Abstract

The use of cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) is associated with substantial morbidity and mortality, especially in the elderly. The purpose of this study was to evaluate the feasibility of beating heart coronary artery revascularization in patients aged at least 80 years. A retrospective chart review was carried out for 17 patients aged over 80 years who underwent isolated off-pump CABG at the Tri-Service General Hospital, Taiwan, during the period July 1999 to December 2000. The demographic characteristics, operative data, postoperative results and short-term outcomes of patients were compared with those of 12 patients who underwent conventional CABG using CPB during the same time period. The off-pump group consisted of 13 men and four women with a mean age of 82.2 +/- 0.9 years and an ejection fraction of 53.4 +/- 4.1%. The on-pump group consisted of eight men and four women with a mean age of 83.5 +/- 0.5 and an ejection fraction of 42.0 +/- 4.8%. The mean number of anastomoses performed per patient was 3.1 +/- 0.3 in the off-pump group and 3.0 +/- 0.14 in the on-pump group. There was no occurrence of stroke, myocardial infarction, re-entry for bleeding or renal failure among patients in the off-pump group. Intubation time (10.6 vs 48.4 h), intensive care unit stay (2.9 vs 4.2 days) and postoperative stay (12.7 vs 18.1 days) were significantly shorter in the off-pump group than in the on-pump group. No patient died in the off-pump group, whereas one patient died in the on-pump group. The results of this study suggest that the off-pump technique is a safe and efficacious method for myocardial revascularization in elderly patients and that the short-term outcome obtained with this technique are promising. Our data suggest that the off-pump technique is preferable in these patients.