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.