Introduction
Ischemic heart disease is the leading cause of death around the
world1. As the global population increases, so is the
proportion of elderly individuals2. This is
particularly prominent in Japan, where the average life expectancy is
over 80 years for both sexes, and the proportion of elderly is
high3. As a result, more and more elderly individuals
with ischemic heart disease are being encountered.
Older patients reportedly show more benefits from any type of
revascularization than from medical therapy, in terms of not only
symptom relief and quality of life, but also long-term
survival4,5.
Compared to percutaneous coronary intervention, coronary artery bypass
grafting (CABG) shows higher mortality and morbidity rates as early
results6. However, the long-term results are better
than those from percutaneous coronary intervention6.
Considering that life expectancy at 80 years old is around 10 years for
the Japanese general population3, long-term results
should be taken into consideration even among octogenarians. CABG may
thus be applicable to elderly patients where feasible, but improvements
in early results are a priority.
Off-pump CABG (OPCAB) eliminates the use of cardiopulmonary bypass, and
so might benefit high-risk patients or complex cases with concomitant
disease7. However, whether OPCAB is better for
octogenarian than conventional CABG remains
controversial7-10. Both methods provide promising
early and mid-term results to octogenarians, once complete
vascularization is achieved10. However, OPCAB seems to
require a certain amount of experience to achieve sufficient results
compared to conventional under-arrest CABG11.
In our institution, OPCAB is the first choice for surgical
revascularization of isolated CABG cases in all generations. Both
surgeons and co-workers are very familiar with the management of OPCAB.
The purpose of this study was to elucidate peri-operative results of
OPCAB in octogenarians with our OPCAB-first strategy and to investigate
differences between octogenarian and younger patients. We also explored
the long-term results for elderly patients and evaluated the validity of
the OPCAB-first strategy among octogenarians.