Background and aim: Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on- or off-pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off-pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off-pump coronary artery bypass-first strategy to all generations since 2008. This study investigated early and long-term results of surgical revascularization for octogenarians by a team with an off-pump-first strategy. Methods: All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age <80 years) and an old group (age >=80 years). Peri-operative results were investigated retrospectively in both groups and long-term results for the old group were assessed. Results: Among the 707 patients, 97% underwent off-pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In-hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow-up of 1318 days, actual 1-, 3-, and 5-year survival rates for octogenarians were 92.1%, 81.2% and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian. Conclusions: An experienced team with an off-pump-first strategy could provide valid therapeutic options for octogenarians.

Background: The benefits of bilateral internal thoracic artery (BITA) grafting during coronary artery bypass grafting in dialysis-dependent end-stage renal disease patients remain unclear. We compared the early and long-term effectiveness of coronary artery bypass using BITA versus single internal thoracic artery (SITA) grafting in this population. Methods: Eighty-nine consecutive patients with dialysis-dependent end-stage renal disease who underwent isolated coronary artery bypass grafting were retrospectively analyzed. Early and long-term results were reviewed, and univariate and multivariate analyses of risk factors for late death and major adverse cardiac events (MACE) was performed. Results: There was no significant difference between the BITA (n = 65) and SITA (n = 24) groups in in-hospital mortality (0% vs. 4.2%, p = 0.27) and the incidence of deep surgical wound infection (4.6% vs. 4.2%, p = 1.00). The overall survival rate in the BITA and SITA groups were 90.2% vs. 82.3%, 64.6% vs. 57.6%, and 51.8% vs. 20.6% at 1, 3, and 5 years, respectively. Overall survival was comparable but was more favorable in the BITA group (p = 0.08). MACE-free rate in the BITA and SITA groups were 96.6% vs. 90.2%, 87.4% vs. 60.6%, and 70.1% vs. 51.8% at 1, 3, and 5 years, respectively. The MACE-free rate was significantly higher in the BITA group (p = 0.04). Conclusions: While BITA grafting did not show a significant survival benefit over SITA grafting, it did not increase surgical complications and improve the MACE-free rate. BITA grafting may be a reasonable surgical strategy in dialysis-dependent patients.