Octogenarians are deemed a high-risk patient population with increased postoperative morbidity and mortality after conventional coronary artery bypass grafting with cardiopulmonary bypass. In such patients, reducing the invasiveness of the surgical procedure by avoiding cardiopulmonary bypass may improve outcomes. This study investigates the in-hospital outcomes, 30-day mortality, and long-term survival rates of off-pump coronary artery bypass (OPCAB) vs on-pump coronary artery bypass (ONCAB) in octogenarians and identifies significant preoperative predictors of long-term mortality.

This retrospective cohort study included octogenarian patients who underwent either OPCAB or ONCAB, between January 1996 and September 2023, at our institution. In-hospital outcomes, 30-day mortality, and long-term survival during 20 years were compared between the groups. Propensity score matching was used to adjust for baseline differences. Statistical analyses included univariate and multivariate Cox regression analyses and Kaplan-Meier survival estimates.

Of 711 patients, 245 pairs were matched. Unmatched analysis showed that OPCAB had lower tracheostomy rates (1.5% vs 4.7%, P = .011) and lower 30-day mortality (3.7% vs 7.5%; P = .027). However, after matching, in-hospital outcomes and 30-day mortality were similar between groups. Long-term survival rates were also comparable. Age (hazard ratio [HR], 1.08; 95% CI, 1.00-1.17; P = .040), previous cardiac surgery (HR, 68.16; 95% CI, 7.88-589.69; P < .001), and left ventricular impairment (HR, 1.59; 95% CI, 1.22-2.08; P < .001) were significant predictors of long-term mortality.

OPCAB may reduce short-term mortality in octogenarians while providing comparable long-term survival to ONCAB. Surgical strategy should be individualized on the basis of preoperative risk profiles.