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Bilateral skeletonized internal thoracic artery grafting in 303 patients seventy years and older
1Department of Thoracic and Cardiovascular Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Bilateral internal thoracic artery grafting is safe for elderly patients, including octogenarians. This technique offers low morbidity and mortality, making it a viable option for selected older individuals.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Geriatric Medicine
Background:
- Internal thoracic artery (ITA) grafts have superior patency rates compared to other arterial or venous grafts.
- Skeletonization technique for bilateral ITA (BITA) grafting preserves sternal collateral flow and reduces leg wound complications.
- Historically, BITA grafting has been reserved for younger patients due to perceived risks.
Purpose of the Study:
- To evaluate the safety and efficacy of BITA grafting using the skeletonization technique in patients aged 70 years and older.
- To assess operative mortality, morbidity, and long-term survival rates in this elderly cohort.
Main Methods:
- A consecutive series of 303 patients aged 70+ underwent coronary artery bypass grafting with BITA using the skeletonization technique between May 1996 and May 1998.
- The cohort included 44 patients aged 80+, and 89 patients with diabetes.
- Mean grafts per patient was 3.1.
Main Results:
- Operative mortality was 2.6%, with higher rates in octogenarians (6.8%) vs. younger elderly (1.9%).
- Sternal wound infection occurred in 2% of patients, with chronic lung disease and emergency operation as predictors.
- One- and 3-year survival rates were 93% and 90%, respectively, with 3-year survival at 92% for octogenarians.
Conclusions:
- BITA grafting with skeletonization demonstrates acceptable morbidity and mortality in elderly patients.
- This surgical approach can be safely recommended for carefully selected elderly patients, including octogenarians.
Objectives:
Higher patency rates of the internal thoracic artery have led myocardial revascularization with bilateral internal thoracic arteries to be a procedure designated primarily for young patients. Fewer leg wound complications and sternal collateral flow preservation with the skeletonizing dissection technique can make bilateral internal thoracic artery grafting attractive also for elderly patients.
Methods:
Between May 1996 and May 1998, 303 consecutive patients aged 70 years or older (mean age 75.5 years; range 70-92 years) underwent coronary artery bypass grafting with double skeletonized internal thoracic arteries. Forty-four (14.5%) patients were 80 years or older, and 89 (28%) had diabetes. The mean number of grafts was 3.1 per patient (2-6).
Results:
Operative mortality was 2.6% (n = 8): it was higher for octogenarians (6.8%) than for younger patients (1.9%) (P =.06). The only significant preoperative predictors of early mortality were complicated percutaneous transluminal coronary angioplasty (P =.03) and preoperative use of intra-aortic balloon pumping (P =.03). Six patients (2%) had sternal wound infections for which chronic lung disease (P =.02) and emergency operation (P =.006) were the only significant predictors. Twenty-two (7.2%) late deaths occurred, and 1- and 3-year survivals were 93% and 90%, respectively. The 3-year survival of patients 80 years old or older was 92%.
Conclusions:
Bilateral grafting of the skeletonized internal thoracic artery carries relatively low morbidity and mortality in elderly patients and can be recommended for selected patients including octogenarians.