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OBJECTIVE: Octogenarians as the fastest growing stratum of the population and with the highest prevalence of coronary artery disease are being increasingly referred for coronary artery bypass grafting (CABG). General perception is that presence of comorbidities and propensity for neurological injury exposes them to a higher risk for mortality and morbidity following conventional on-pump CABG and therefore off-pump CABG should be preferentially offered to octogenarians to improve outcomes. This study evaluates the in-hospital outcomes and predictors of mortality and stroke in octogenarians undergoing on- and off-pump CABG at our institution.
METHODS: From January 2000 to December 2010, 290 octogenarians underwent off-pump (n = 217) and on-pump (n = 73) CABG. Their data were prospectively entered into the cardiac surgery database (PATS; Dendrite Clinical Systems, Ltd, Oxford, UK) and analyzed retrospectively. Outcome measures included in-hospital mortality, major complications, and length of stay. Multivariate analysis was performed to identify predictors of combined outcome of in-hospital mortality and stroke.
RESULTS: The mean age of the patients was 82 ± 2.0 years. Preoperative demographics were similar for the on-pump and off-pump groups. Patients operated off-pump had lower number of distal anastomoses performed compared to patients operated on-pump (mean difference = 0.2, 95% CI = 0.02-0.4; p = 0.03). However, the ratio of grafts (received/needed) was the same in both groups. In-hospital mortality for the entire cohort was 7.2% with no significant difference between the groups for death (6.0% vs 11.0%; p = 0.08), stroke (2.8% vs 2.8%; p =1.0), other major complications and length of hospital stay. Independent predictors of combined outcome identified from the multiple logistic model included heart failure (OR = 4.4, 95% CI = 1.5-13.0; p = 0.008), diabetes (OR = 2.6, 95% CI = 1.0-6.0; p = 0.046), nitrate infusion ((OR = 2.9, 95% CI = 1.1, 8.0; p = 0.04), postoperative renal failure requiring hemofiltration (OR = 8.6, 95% CI = 3.5-21.1; p < 0.001), and postoperative ventricular arrhythmias (OR = 7.3, 95% CI = 1.9-27.8; p = 0.009).
CONCLUSIONS: Careful patient selection and individualized treatment decisions can minimize postoperative mortality and morbidity in octogenarians undergoing on- and off-pump CABG.