Anaortic Off-Pump Coronary Artery Bypass Grafting in the Elderly and Very Elderly

Background Elderly patients undergoing surgical revascularisation may disproportionately benefit from avoiding manipulation of the ascending aorta and cardiopulmonary bypass. In this multi-centre observational study, we sought to determine the 30-day outcomes of anaortic off-pump coronary artery bypass (OPCAB) in an elderly and very-elderly population. Methods Data were prospectively collected for all patients aged >70 years old (y) undergoing anaortic OPCAB at three hospitals between January 2002 and October 2011. Analysis was carried out on two age sub-groups (70–79y vs. ≥80y). Multiple logistic regression was used to identify predictors of post-operative 30-day mortality. Results In total, 1135 patients >70 years underwent anaortic OPCAB – 817 (72%) patients were aged 70–79y while 318 (28%) were aged ≥80y. The rate of mortality and morbidity for both groups was low: 30-day mortality (70–79y: 1.8%; ≥80y: 2.8%) or permanent stroke (70–79y: 0.2%; ≥80y: 0.9%). Chronic lung disease, a history of previous myocardial infarction and left main disease were independent predictors of 30-day mortality. Conclusions OPCAB is associated with low rates of 30-day mortality and peri-operative stroke in this elderly and very elderly patient cohort. Anaortic OPCAB can provide excellent short-term post-operative outcomes and may give the elderly and very elderly population the opportunity to benefit from surgical coronary revascularisation.