CLINICAL CHARACTERISTICS AND EARLY OUTCOMES OF PATIENTS AGED 70 YEARS AND OLDER UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Hasan Al Imran, Wei Wang*

ABSTRACT

Background: Coronary artery bypass grafting (CABG) is an effective treatment for coronary heart disease, yet its safety in elderly patients (aged >70 years) remains a subject of debate. This study evaluated the clinical profiles and short-term mortality in elderly patients undergoing on-pump versus off-pump CABG. Methods: We retrospectively analyzed 124 patients aged 70–83 years who underwent first-time CABG at The Affiliated Hospital of Yangzhou University between January 2018 and December 2023. Patients were divided into on-pump (n=92) and off-pump (n=32) groups. Preoperative, intraoperative, and postoperative outcomes were compared. Statistical analyses employed t-tests and χ² tests, with P<0.05 considered significant. Results: Preoperative comorbidities were prevalent, with hypertension (75.8%) and three-vessel disease (64.5%) significantly more common in the on-pump group (P<0.01). The left internal mammary artery was used in 56.5% of patients and complete revascularization achieved in 81.5%, both significantly higher in on-pump surgery (P<0.01). Postoperative outcomes, including mechanical ventilation duration (12.3±3.5 hours), ICU stay (3.8±1.5 days), and total hospital stay (18.7±6.9 days), did not differ significantly between groups. Pleural effusion was more frequent after off-pump CABG (21.9% vs. 4.3%, P<0.01). In-hospital mortality was 4.8%, with no significant between-group difference (P>0.05). Pulmonary infection was the most common complication (15.3%). Conclusions: Both on-pump and off-pump CABG appear safe in elderly patients, with comparable short-term mortality. The higher rates of hypertension, stroke history, and three-vessel disease in on-pump patients suggest this approach may be preferred for more complex cases. Comprehensive perioperative management remains essential in this vulnerable population.

Keywords: Coronary artery disease; off-pump coronary artery bypass grafting; selection of operative technique; perioperative management.