Background: Octogenarians are being increasingly referred for coronary artery bypass grafting (CABG). However, there is a paucity of studies reporting impact of choice of surgical revascularization strategy on in-hospital mortality and mid-term survival of octogenarians. We evaluated our institutional experience to determine the impact of off-pump and on-pump CABG on in-hospital mortality and mid-term survival of octogenarians. Methods: We retrospectively analysed prospectively collected data from the Patients Analysis and Tracking System database (Dendrite Clinical Systems, Oxford, UK) for all isolated first-time CABG procedures with at least 2 grafts performed at our institution from January 2000 to September 2017. Over the study period, 566 octogenarians underwent either off-pump (N = 374) or on-pump CABG (N = 192). Short-term outcomes including in-hospital mortality as well as mid-term survival was compared for the two groups. Results: The two groups had similar preoperative demographics and mean number of distal anastomoses (off-pump: 2.7 ± 0.6 [median 3] vs on-pump: 2.7 ± 0.3 [median 3]; P=0.6). However, more bilateral internal mammary artery grafts were performed in the off-pump cohort compared to on-pump cohort (117 [31.3%] vs 22 [11.5%]; P <0.001). In-hospital mortality for the entire cohort was 5.7% with significantly fewer deaths in the off-pump cohort (4.3% vs 8.3%; P=0.04). The remaining in-hospital outcomes were similar. Kaplan-Meier survival at 1 year (89.7% vs 82.9%; P=0.048) and 5 year (71.1% vs 61.3%; P=0.038) was significantly better for the off-pump cohort. Conclusion: Octogenarians experience lower in-hospital mortality and improved mid-term survival after off-pump CABG compared to on-pump CABG.

Background The coronavirus-disease 2019 (COVID-19) pandemic imposed an unprecedented burden on the provision of cardiac surgical services. The reallocation of workforce and resources necessitated the postponement of elective operations in this cohort of high-risk patients. We investigated the impact of this outbreak on the aortic valve surgery activity at a single two-site centre in the United Kingdom. Methods and Results Data were extracted from the local surgical database, including the demographics, clinical characteristics, and outcomes of patients operated on from March 2020 to May 2020 and compared with the respective 2019 period. The experience of centres world-wide was invoked to assess the efficiency of our services. There was a 38.2% reduction in the total number of operations with a 70% reduction in elective cases, compared with a 159% increase in urgent and emergency operations. The attendant surgical risk was significantly higher [median Euroscore II was 2.7 [1.9-5.2] in 2020 versus 2.1 [0.9-3.7] in 2019 (p=0.005)] but neither 30-day survival nor freedom from major post-operative complications (re-sternotomy for bleeding/tamponade, transient ischemic attack/stroke, renal replacement therapy) was compromised (p>0.05 for all comparisons). Conclusion RBHT managed to offer a considerable volume of aortic valve surgical activity over the first COVID-19 outbreak to a cohort of higher-risk patients, without compromising post-operative outcomes. A backlog of elective cases is expected to develop, the accommodation of which after surgical activity normalisation will be crucial to monitor.