Multivessel Off-Pump Revascularization in High-Risk Populations

The elderly population in the United States is growing exponentially. It is estimated that by the year 2050 there will be 38 million octogenarians (up from 9 million in 2002) (1). Increasingly, government initiatives are being created in an attempt to qualify their health status, ascertain their functional limitations, and identify their morbidity and mortality. It is well known that 25% of octogenarians have severe functional limitations secondary to cardiovascular disease (2). Furthermore, cardiovascular disease has been, and continues to be, the number one cause of death in people over 65 yr of age (3). Many of these patients have disease refractory to medical therapy, which has led to a marked increase in the number of elderly patients being referred for coronary revascularization. Over the last decade, numerous investigators have reported on the feasibility and efficacy of cardiac surgery in this population. Most remarkably, the preponderance of studies underscore the high-risk profile of elderly patients with their higher prevalence of comorbidities and left ventricular dysfunction as well as the greater severity of coronary artery disease (4–10). Several reports indicate that coronary revascularization can be performed with an acceptable mortality in octogenarians (4,6,7,11) and efforts are now aimed at further decreasing morbidity and mortality after coronary bypass in this older population.