Off-pump coronary artery surgery in the elderly.

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Thoracic Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
• The choice between off-pump (OPCAB) and on-pump (traditional) CABG in elderly patients remains a subject of ongoing research.
• Elderly patients present unique challenges due to comorbidities and potential for increased surgical risk.

Purpose of the Study:

• To compare the clinical outcomes of off-pump versus on-pump coronary artery bypass grafting in patients aged 70 years and older.
• To evaluate differences in operative mortality, morbidity, and resource utilization between the two surgical techniques.
• To determine the safety and efficacy of OPCAB in a geriatric population.

Main Methods:

• A retrospective study comparing 186 patients who underwent OPCAB with 389 patients who underwent on-pump CABG.
• Patients were aged 70 years or older, and those requiring single-vessel revascularization were excluded.
• Preoperative risk factors were matched between the two groups to ensure comparability.

Main Results:

• Operative mortality was similar between groups (2.2% for OPCAB vs. 4.6% for on-pump).
• The OPCAB group demonstrated significantly better outcomes, including shorter intubation times, reduced blood loss, and lower rates of blood transfusion.
• Further benefits for OPCAB included decreased reoperation for bleeding, lower incidence of atrial fibrillation, shorter intensive care unit stays, and reduced total hospital stay.

Conclusions:

• Off-pump coronary artery bypass grafting is a safe and effective alternative for elderly patients undergoing multi-vessel revascularization.
• OPCAB is associated with significantly reduced morbidity and shorter hospitalization periods compared to on-pump CABG in this age group.
• These findings support the consideration of OPCAB for selected elderly patients to improve recovery and resource efficiency.