Multivessel off-pump coronary artery bypass grafting in a nonagenarian: anesthesiologic management

Area of Science:

• Cardiovascular Surgery
• Geriatric Anesthesia

Background:

• Elderly patients face increased risks for mortality and morbidity following coronary artery bypass grafting (CABG).
• Optimal anesthetic and surgical strategies are crucial for managing high-risk elderly patients undergoing cardiac procedures.

Observation:

• A 90-year-old male with three-vessel disease, hypertension, and chronic renal failure underwent elective CABG.
• The procedure utilized median sternotomy, coronary stabilization, and shunting without cardiopulmonary bypass.
• Cerebral and renal perfusion were maintained using high arterial pressure and fenoldopam infusion.

Findings:

• The patient's perioperative period was uneventful, indicating successful management.
• The anesthetic regimen included propofol, isoflurane, opioids, and atracurium.
• Maintaining adequate perfusion pressures and utilizing specific pharmacological agents were key to successful outcomes.

Implications:

• Elective CABG can be performed safely in very elderly patients, even those with significant comorbidities.
• Avoiding cardiopulmonary bypass in this population may reduce the incidence of perioperative complications.
• This case highlights the feasibility of off-pump CABG in high-risk geriatric patients, preserving organ perfusion.