Prediction of complications and death in octogenarians with left main coronary artery disease after coronary artery bypass implantation - off-pump, on-pump and minimally invasive techniques comparison.

Abstract

IntroductionOff-pump coronary artery bypass grafting is considered potentially more effective than on-pump surgery in elderly patients.AimTo compare the early and long-term results of these techniques in patients ≥ 80 years of age with left main coronary artery disease.Material and methodsAll patients ≥ 80 years of age (N = 3648) who were reported to the Polish National Registry of Cardiac Surgery Procedures between 2006 and 2016 and underwent primary, isolated coronary artery bypass surgery were included in the study. The patients were divided into 2 groups: group A – without significant left main stenosis (LMS) (n = 2094) and B group – with LMS ≥ 50% (n = 1524). The groups were compared according to the type of surgery: on-pump (A = 1107 vs. B = 891), off-pump (A = 908 vs. B = 616) and MIDCAB (A = 79 vs. B = 17).ResultsThere were significant differences in preoperative status between the groups in the whole cohort, which were not observable after propensity score matching. The in-hospital mortality was significantly higher in the LMS group operated on-pump (10.5% vs. 7.0%; p = 0.01) and non-significant in the off-pump group (5.1% vs. 5.7%; p = 0.78), as well as in the MIDCAB subgroup (5.9% vs. 5.1%; p = 0.64). 10-year survival in all subgroups was comparable and remained at a level of 50–60%. The mean entire cohort follow-up was 3.4 ±2.7 vs. 3.7 ±2.8 years (p = 0.2).ConclusionsOff-pump coronary bypass grafting may optimize the outcomes in elderly patients with significant left main stenosis. Octogenarians surgically treated for coronary artery disease, despite increased post-operative risks, present encouraging long-term survival.