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Off-pump coronary artery revascularization in octogenarians: is it better?

Cartier, Raymond

doi: 10.1097/HCO.0b013e32833124f5
Coronary artery surgery: Edited by Thierry G. Mesana

Purpose of review Octogenarians are the fastest growing stratum of the population and have the highest prevalence of coronary artery disease. In the past, physicians have been reluctant to provide these patients with optimal care. Seniors are frequently excluded from large randomized trials and generally not included in published guidelines. The purpose of this review is to revisit the demography and epidemiology of coronary artery disease in this population as well as therapeutic strategies used.

Recent findings Recent publications have shown significant advancement in medical and invasive treatment of coronary artery disease in elderly, with special focus on the potential benefit of off-pump coronary artery bypass (OPCAB) surgery.

Summary Although OPCAB surgery has gained popularity over the past 15 years, its benefit regarding operative mortality and major complications has not been clearly defined in the general population. There is a body of literature supporting its benefit in the elderly population. OPCAB surgery has the potential of decreasing operative mortality and major postoperative complications such as stroke, delirium, atrial fibrillation, and decline in neurocognitive functions in these patients. Off-pump surgery is technically more demanding and has been blamed for providing less complete revascularization and lower graft patency rate, especially in less experienced hands. However, with the upcoming demographic explosion of senior citizens in western societies, OPCAB surgery has definitely to be a part of the armamentarium of modern cardiac surgeons.

Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada

Correspondence to Raymond Cartier, Department of Cardiac Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada Tel: +1 514 376 3330x3715; fax: +1 514 593 2157; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.