Off-pump bypass surgery may be the best option for patients over 80 years in age because it results in fewer strokes and higher 30-day survival rates, according to an article in the September 17th special surgery issue of Circulation.

"Off-pump bypass surgery has become a viable technique in the past five to six years because of new technology," says senior author Louis P. Perrault, M.D., Ph.D. "However, until now, surgeons have been unable to identify in which patients the technique is most beneficial. This study provides striking evidence that patients over 80 are a subgroup who can benefit greatly from off-pump surgery."

Patients over age 80 years are known to be at high risk for complications after bypass surgery. Some physicians have suggested that the less invasive off-pump technique may be a better option for these patients.

Researchers tested the hypothesis by reviewing bypass surgery records. Between 1995 and 1999, 125 patients over 80 years had bypass surgery, 63 on-pump and 62 off-pump. The two groups were very closely matched in preoperative health characteristics such as left ventricular function, number of artery or vein grafts, as well as age and gender. The 30-day postoperative mortality rate was 15.9 percent in the on-pump group and 4.8 percent in the off-pump group.

Four postoperative strokes occurred in the on-pump group and none in the off-pump group. Another important difference between groups was that the off-pump patients needed fewer blood transfusions. A prospective randomized study is underway in the same Canadian center to confirm these findings.

"Even though the design of this study isn't perfect," Perrault says, "the results are hard to ignore. If some centers are not believers in off-pump bypass surgery, these findings should encourage them to rethink their position in the over-80 group."