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.