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Effect of age on outcome of bilateral skeletonized internal thoracic artery grafting
1Department of Thoracic and Cardiovascular Surgery, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
Older patients undergoing coronary artery bypass grafting with double skeletonized internal thoracic arteries had similar operative mortality. However, advanced age was linked to increased perioperative morbidity and late mortality, but lower angina recurrence.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Thoracic Surgery
Background:
- Elderly patients face higher risks in coronary artery bypass grafting (CABG).
- Arterial myocardial revascularization using internal thoracic arteries was typically for younger patients.
- This study assesses age as a factor in CABG outcomes using double skeletonized internal thoracic artery grafts.
Purpose of the Study:
- To evaluate the impact of patient age on the outcomes of coronary artery bypass grafting.
- To determine if advanced age is a risk factor for mortality and morbidity in patients receiving double skeletonized internal thoracic artery grafts.
Main Methods:
- A retrospective analysis of 634 patients undergoing double skeletonized internal thoracic artery grafting.
- Patients were stratified into five age groups ( <60, 60-65, 65-70, 70-75, >75 years).
- Preoperative risk factors were compared across age groups; outcomes were analyzed for mortality, myocardial infarction, stroke, and sternal wound infections.
Main Results:
- Overall hospital mortality was 2.5%, with no significant difference based on age for operative mortality.
- Advanced age correlated with increased early unfavorable events (6.7% to 15.2%) and late mortality (0.6% to 9.8%).
- Older patients experienced lower rates of early angina return (2.6% to 0%).
Conclusions:
- Older age is not a risk factor for operative mortality in CABG using double skeletonized internal thoracic arteries.
- While avoiding leg incision morbidity, older patients had higher perioperative morbidity and late mortality.
- Older patients demonstrated a trend towards lower rates of angina recurrence post-surgery.
Background:
Elderly patients are considered to be at higher risk for coronary artery bypass grafting. Surgical techniques of arterial myocardial revascularization without vein grafts were primarily reserved for the young. This report evaluates the impact of age on the outcome of 634 consecutive patients who underwent double skeletonized internal thoracic artery grafting between April 1996 and December 1997.
Methods:
Patients were stratified into five age groups: One hundred ninety-six were less than 60 years of age, 98 between 60 and 65 years, 132 between 65 and 70 years, 116 between 70 and 75 years, and 92 were older than 75 years. The groups did not differ with regard to preoperative risk factors.
Results:
Hospital mortality was 2.5% (n = 16). Mortality of urgent and elective operations was 1.6%, and that of emergency operations was 9.7% (p < 0.001). There were 7 (1.1%) myocardial infarctions, 9 strokes (1.4%), and 10 deep sternal wound infections (1.6%). Using the Mantel-Haenszel test, there was no relation between age and hospital mortality, myocardial infarctions, strokes, or sternal infections. A correlation was found between advanced age and early unfavorable events (6.7%, 7.2%, 12.9%, 15.5%, and 15.2% in corresponding age groups, p < 0.003), and late mortality (0.6%, 1%, 1.5%, 4.3%, and 9.8%, respectively, p < 0.01). However, early return of angina was lower (2.6%, 1%, 0.8%, 0.9%, and 0%, p < 0.06).
Conclusions:
This retrospective, nonrandomized study suggests that older age is not a risk factor for operative mortality in patients undergoing coronary artery bypass grafting with double skeletonized internal thoracic arteries. Apart from avoiding morbidity associated with leg incisions, older patients showed an interesting trend toward lower rates of angina return. Older patients, however, sustained increased perioperative morbidity and late mortality rates.