Coronary Artery Bypass Surgery in Octogenarian Patients: A Multicenter Retrospective Study- Should OPCAB be preferred?

R. Reddy¹, M. Anamul. Islam², A. Malhotra¹, G. Tavilla¹, T. D'amato¹, M. Baldawi¹, S. Gupta¹, R. Smith¹, C. Roberts³, M. Mack⁴, J. Michael. DiMaio^4
1Baylor Scott & White Health, Temple, Texas ²Baylor Scott & White Health, Belton, Texas ³Baylor Scott & White Health, Dallas, Texas ⁴Baylor Scott & White Health, Plano, Texas

Purpose: Coronary Artery Bypass Grafting (CABG) in octogenarians is becoming commonplace. This entails potentially higher risk and resource utilization. We undertook this multicenter retrospective study to evaluate the overall results of CABG in octogenarians and the impact of the Off-pump technique.

Methods: The Baylor Scott and White Health system has 8 centers performing heart surgery. A total of 6,721 isolated CABG surgeries, including 470 (7%) in octogenarians was performed from Jan 2015 to Jun 2023. Our database included all the cases submitted to the STS and used the same definitions as the STS database. In addition to the overall results, we evaluated the impact of OPCAB and ONCAB surgeries within the octogenarian cohort. We performed a propensity based stabilized inverse probability weighted matching technique between the two procedures to mitigate biasness in baseline covariates. This resulted in 121 OPCAB and 201 ONCAB weighted octogenarian patients. Wherever appropriate, a T-test or Mann-Whitney U test for numerical variables, and a Chi-squared or fisher exact test for categorical variables was performed for comparisons.

Results: The 30-day mortality rate was 4.15% (279/6721) but was higher in octogenarians 6.6%(31/470); p = 0.012. 205 octogenarians (43.6%) underwent OPCAB and 265(56.4%) ONCAB. 30-day mortality was 6.7% (14/205) for OPCAB vs. 6.4% (17/265) for ONCAB; p = 0.707. Stroke rates were 0% for OPCAB vs. 1.5% (4/265) for ONCAB; p = 0.136. Overall complications were OPCAB 87(42.4%) vs. ONCAB 161(60.8%); p < 0.0001, including pneumonia 1(0.5%) vs. 14(5.3%); p = 0.003, renal failure 3(1.5%) vs. 16(5.6%); p = 0.026, and atrial fibrillation 50(24.4%) vs. 113(42.6%); p < 0.0001). Transfusion rates were 29% (59/205) vs. 39% (104/265); p = 0.018. Median (IQR) length of hospital stay was 6[2-8] vs. 7[6-10] days; p < 0.0001) and ICU hours were 57[24-96] vs. 72[45-119] hours; p = 0.002).
Among the matched patients, 30-day mortality was 2.4% (3) for OPCAB vs. 4.4% (9) for ONCAB; p = 0.598. Stroke rates were similar 0% vs. 0.8% (2/201); p = .312. Post-operative complications were 53(44%) vs. 122(61%); p = .003. Median (IQR) length of hospital stay was 6[3-7] vs. 7[6-10] days; p = 0.002. 85 (70%) of the OPCAB patients were discharged home vs. 106(53%); p = 0.003.

Conclusion: In octogenarian patients, we showed comparable mortality and stroke risks for OPCAB and ONCAB. However, OPCAB showed reduced complications, shorter hospital stays, fewer ICU hours, higher discharge-to-home rates, and decreased blood transfusion requirements. These findings may support OPCAB as a safer cost-effective alternative in octogenarians.

Identify the source of the funding for this research project: None