Coronary Artery Bypass Grafting in the Very Elderly (≥80 Years): A Retrospective Comparison of On-Pump and Off-Pump Techniques With Emphasis on Recovery Patterns.

Abstract

Aim: To systematically compare the perioperative safety, early recovery, and mid-term clinical outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in very elderly patients (≥80 years).

Methods: This single-center retrospective study enrolled 62 very elderly patients (≥80 years) undergoing isolated CABG from 2012 to 2022, assigned to on-pump (n = 22) or off-pump (n = 40) groups. Baseline characteristics, intraoperative data, and one-year follow-up outcomes were collected and compared. The primary endpoint was 30-day major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, stroke, and myocardial infarction. Secondary endpoints included the individual components of MACCE and key recovery metrics (duration of mechanical ventilation, intensive care unit (ICU) length of stay, and total hospital length of stay).

Results: No statistically significant differences were observed between the two groups in perioperative mortality, incidence of major adverse cardiac and cerebrovascular events (including stroke and myocardial infarction), or one-year survival rates (p > 0.05). The off-pump group had significantly shorter median durations of postoperative mechanical ventilation (15 hours vs. 20.5 hours, p = 0.014) and ICU stay (3 days vs. 5 days, p = 0.007) compared to the on-pump group. However, there were no statistically significant differences in median total postoperative hospitalization (14 days vs. 15 days, p = 0.525) or in the time from ICU transfer to discharge (10 days vs. 9.5 days, p = 0.318). Analysis of postoperative complications revealed a high incidence of severe pulmonary inflammation, with no statistically significant difference between the groups. New-onset postoperative stroke was identified as a leading cause of early and mid-term mortality in this population.

Conclusions: In this exploratory retrospective analysis of selected very elderly patients, both on-pump and off-pump CABG demonstrated comparable survival and major adverse event outcomes. Although the off-pump group exhibited a statistically significant signal toward faster early physiological recovery (shorter ventilation and ICU stay), this observation warrants cautious interpretation due to baseline imbalances and should be considered hypothesis-generating rather than definitive. These preliminary findings highlight the need for future risk stratification tools and integrated care pathways, rather than prescribing a specific surgical technique based on recovery speed alone.