Aorta No-Touch Off-Pump Coronary Artery Revascularization in Octogenarians: 5 Years' Experience


  • Sotirios N. Prapas
  • Ioannis A. Panagiotopoulos
  • Dimitar N. Pentchev
  • Mohamed A. Salama Ayyad
  • Dimitrios A. Protogeros
  • Vasilios N. Kotsis
  • Ioannis N. Linardakis
  • Theofanis P. Tzanavaras
  • Poly T. Stratigi



Background: Approximately 18% of octogenarians have ischemic heart disease. Increasingly, they are being referred for coronary artery revascularization by surgical and/or percutaneous procedures. These strategies have been questioned, however, because of reports of poor outcomes in the elderly. In this study, we aimed to determine the impact of age on morbidity and mortality in patients undergoing off-pump coronary artery bypass (OPCAB) with the ?-circuit procedure during 5 years of follow-up.

Materials and Methods: From February 2001 to November 2005, 1359 patients underwent isolated coronary revascularization with the ?-circuit technique, which consists of (1) beating heart surgery, (2) OPCAB, (3) no touching of the aorta, (4) use of composite grafts, and (5) arterial revascularization. Sixty-two patients were ?80 years of age (group A), and 1297 were <80 years old (group B). Both groups were compared with respect to preoperative risk factors, intraoperative parameters, and postoperative morbidity and mortality. Follow-up lasted from 4 to 60 months. Data were analyzed with the ?2 test, the Fisher exact test, the Kaplan-Meier method, and the Cox model of regression analysis.

Results: Females predominated among the octogenarians (P < .0005). Octogenarians more frequently underwent emergent operations (P < .031) and had worse ejection fractions (P < .026). Obesity was also less prevalent among these patients (P < .007). There were no differences between the groups in the preoperative and postoperative use of an intraaortic balloon pump. Octogenarians had lower cholesterol levels (P < .0005) and had fewer distal anastomoses (2.24 ± 0.0.76 versus 2.77 ± 0.92, P < .0005). The 2 groups were not significantly different with respect to 30-day mortality (3.2% versus 1.5%) and 7-day mortality (1.6% versus 0.2%). Differences were noted in the incidences of pulmonary complications (12.9% versus 5.6%, P < .027), atrial fibrillation (41.9% versus 19%, P < .0005), and cognitive disturbances (6.5% versus 0.3%, P < .0005). During follow-up, survival seemed to favor the younger group (P < .001). Nevertheless, further analysis of the data with the Cox regression model to exclude confounding risk factors, revealed the survival rates of the 2 groups to be similar.

Conclusions: Use of the ?-circuit technique is very effective for octogenarians. Although these older patients have a higher incidence of early postoperative morbidity, overall survival is not affected.


Alexander KP, Anstron KJ, Muhlbaier LH, et al. 2000. Outcomes of cardiac surgery in patients ?80 years: results from the National Cardiovascular Network. J Am Coll Cardiol 35:731-8.nBergsland J, Hasnan S, Lewin N, Bhayuany J, Lajos TZ, Salerno TA. 1997. Coronary artery bypass grafting without cardiopulmonary bypass—an attractive alternative in high risk patients. Eur J Cardiothorac Surg 11:876-80.nCraver JM, Puskas JD, Weintraub WW, et al. 1999. 601 octogenarians undergoing cardiac surgery: outcome and comparison with younger age groups. Ann Thorac Surg 67:1104-10.nGhosh P, Djordjevic M, Schistek R, Baier R, Unger F. 2003. Does gender affect outcome of cardiac surgery in octogenarians? Asian Cardiovasc Thorac Ann 11:28-32.nHannan EL, Burke J. 1994. Effect of age on mortality in coronary artery bypass surgery in New York, 1991-1992. Am Heart J 128:1184-91.nHeijmeriks JA, Pourrier S, Dassen P, Prenger K, Wellens HJ. 1999. Comparison of quality of life after coronary and/or valvular cardiac surgery in patients 75 years of age with younger patients. Am J Cardiol 83:1129-32.nMack MJ, Acuff T, Osborne J. 1998. Minimally invasive direct coronary artery bypass: technical considerations and instrumentation. J Card Surg 13:290-6.nMerrill WH, Stewart JR, Frist WH, Hammon JW Jr, Bender HW Jr. 1990. Cardiac surgery in patients age 80 years or older. Ann Surg 211:772-6.nMichael JW, Michael SJ, Woods ES, Hendy MP, Hiratzka LF. 2005. Cardiac surgery in octogenarians: Does age alone influence outcomes? Arch Surg 140:1089-93.nMuneretto C, Bisleri G, Negri A, et al. 2004. Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation. J Thorac Cardiovasc Surg 127:179-84.nNashef SAM, Roques F, Michel P, et al. 1999. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16:9-13.nNational Nursing Home Survey. 1985. Hyattsville, Md: National Center for Health Statistics.nNewman S. 1989. The incidence and nature of neuropsychological morbidity following cardiac surgery. Perfusion 4:93-100.nParolari A, Alamanni F, Cannata A, et al. 2003. Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials. Ann Thorac Surg 76:37-40.nPotger KC, McMillan D, Connolly T, Southwell J, Dando H, O'Shaughnessy K. 2002. Coronary artery bypass grafting: an off-pump versus on-pump review. J Extra Corpor Technol 34:260-6.nPrapas SN, Panagiotopoulos IA, Abdelsalam AH. 2007. Predictors of prolonged mechanical ventilation following aorta no-touch off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg 32:488-92.nPrapas SN, Anagnostopoulos CE, Kotsis VN, et al. 2002. A new pattern for using both thoracic arteries to revascularize the entire heart: the -graft. Ann Thorac Surg 73:1990-2.nRasmussen LS. 1998. Defining postoperative cognitive dysfunction. Eur J Anaesthesiol 15:761-4.nSollano JA, Rose EA, Williams DL, et al. 1998. Cost-effectiveness of coronary artery bypass surgery in octogenarians. Ann Surg 228:297-306.nTasdemir O, Vural KM, Karagoz H, Bayazit K. 1998. Coronary artery bypass grafting on the beating heart without the use of extracorporeal circulation: review of 2052 cases. J Thorac Cardiovasc Surg 116:68-73.nWennberg DE, Makenka DJ, Sengupta A, et al. 1999. Percutaneous transluminal coronary angioplasty in the elderly: epidemiology, clinical risk factors, and in-hospital outcomes. The Northern New England Cardiovascular Disease Study Group. Am Heart J 137:639-45.n



How to Cite

Prapas, S. N., Panagiotopoulos, I. A., Pentchev, D. N., Ayyad, M. A. S., Protogeros, D. A., Kotsis, V. N., Linardakis, I. N., Tzanavaras, T. P., & Stratigi, P. T. (2009). Aorta No-Touch Off-Pump Coronary Artery Revascularization in Octogenarians: 5 Years’ Experience. The Heart Surgery Forum, 12(6), E349-E353.




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