Off-pump coronary surgery improves in-hospital and early outcomes in octogenarians

A retrospective study on octogenarians who underwent off-pump (OPCAB) or conventional (CCAB) coronary artery bypass surgery undertaken to evaluate the in-hospital and early outcomes in terms of survival and cardiac and neurological events.

The design of the study was single-institutional, retrospective and comparative. Between January 1997 and May 2003, 114 patients were included and 73 underwent OPCAB, while 41 underwent CCAB. Uni- and multivariate analyses were used to determine the correlation between the pre- and intraoperative data and hospital death or complications. The overall survival and freedom from cardiac events were determined using Kaplan-Meier analysis. The linearized rates of follow-up complications were compared between the two groups.

Overall, comparison of CCAB to OPCAB revealed differences in the operative mortality (6 deaths for CCAB, 14.6% vs 5 deaths for OPCAB, 6.8%; p = 0.05). Postoperative complication variables showed that there was no significant difference in the number of patients who suffered from cardiac events and stroke (2.4% CCAB vs 1.4% OPCAB, p = NS) whereas there was a significant difference for minor neurological events (12.2% CCAB vs 2.8% OPCAB, p = 0.04). The mean follow-up was 2.1 +/- 1.8 years, for a total follow-up of 234 patient-years. There were 12 late deaths, 6 in the CCAB group and 6 in the OPCAB group. The linearized rate of overall death was 9.5 +/- 2.6%/year in the CCAB group and 13.3 +/- 3.9%/year in the OPCAB group (p = NS). The actuarial survival at 24 months was 84 +/- 7% for OPCAB and 81 +/- 12% for CCAB (p = NS). The actuarial freedom from cardiac events at 24 months was 89 +/- 4% for OPCAB and 90 +/- 6% for CCAB (p = NS). The linearized rate of neurological events was 0.7 +/- 0.7%/year for the CCAB group and 1.1 +/- 1.1%/year for the OPCAB group (p = NS).

Our analysis shows that OPCAB improves the early outcome and that octogenarians can lead event-free lives after cardiac surgery.