Myocardial revascularization in the elderly using beating heart coronary artery bypass surgery

Background. Beating heart or “off-pump” coronary artery bypass (OP-CAB) has become an accepted method of myocardial revascularization by reducing the perioperative morbidity related to cardiopulmonary bypass (CPB). However, the efficacy of OP-CAB has not been well established in the elderly patient population. Methods. OP-CABs were performed in 53 patients aged 75 years and older, at Pitt County Memorial Hospital from January 1996 to October 1999, either through a median sternotomy or an anterior thoracotomy. These results were compared with 220 patients who underwent standard coronary artery bypass graft (CABG) operation using CPB during the same time period. Results. Mean patient age for both groups was 79 ± 0.5 years and preoperative risk factors were similar. There were no differences in postoperative myocardial infarction, atrial fibrillation, bleeding, neurologic complications, or renal failure. There were no deaths after OP-CAB, compared with the 7.6% operative mortality rate after CABG (p< 0.05). The OP-CAB group had a significantly shorter postoperative length of stay (4.4 ± 0.4 days vs 8.4 ± 0.6 days) and lower transfusion requirements (0.4 ± 0.1 units packed red blood cells vs 1.9 ± 0.2 units packed red blood cells) than the CABG group. Conclusions. Our data demonstrate that OP-CAB is a safe and efficacious method of myocardial revascularization in the elderly, and may actually be preferential in these patients when applicable.