[Off-pump versus on-pump coronary artery bypass surgery. Comparison of 270 case-matched elderly patients]

Abstract

Introduction: Off-pump versus on-pump coronary artery bypass surgery: it still remains a matter of debate which method results in a lower incidence of perioperative morbidity and mortality. This case-matched study evaluates the outcome of elderly patients in both groups.

Methods: All patients aged 75 and older, who underwent CABG from 1998 to 2002, were examined retrospectively. They were matched according to Euroscore and the number of diseased vessels. The Student's t-test and chi-square test were used where appropriate.

Results: 270 CABG patients were considered: 135 off-pump and 135 on-pump patients. Mean age was 78.4 +/- 3.1 versus 77.5 +/- 2.9 years, respectively. EuroSCORE was 7.11 +/- 2.3 in both groups; number of distal anastomoses per patient 1.7 +/- 0.74 versus 2.6 +/- 0.63 (p < 0.001), operation time 138 versus 177 minutes (p < 0.001). There were no significant differences in postoperative complications including hospital mortality 3.0 versus 3.7%, renal failure 8.9 versus 12.1% (new onset), acute myocardial infarction 1.5 versus 4.4% and cerebral events 0 versus 1.5%, respectively. The number of transfused packed cells was 2.6 +/- 2.8 versus 4.6 +/- 5.3 (p < 0.001). Intubation time and ICU stay were similar in both groups.

Conclusion: OPCAB is not associated with a reduction of perioperative mortality and morbidity in patients aged 75 and older.