Extended use of bilateral internal thoracic arteries for coronary artery bypass grafting in the elderly
Takashi Hirotani1, Tsukasa Nakamichi, Mamoru Munakata
1Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan.
Objective:
Internal thoracic artery (ITA) grafts provide better early and long-term patency than saphenous vein (SV) grafts. Furthermore, bilateral ITA grafting has recently demonstrated better long-term results than unilateral ITA grafting. However, its use in the elderly is controversial.
Methods:
From March 1991 through November 2001, 307 consecutive patients aged 65 years or over undergoing isolated coronary artery bypass grafting (CABG) were reviewed, and the influence of bilateral ITA grafting on the early and long-term results was evaluated. All ITA grafts were harvested as a pedicle, and almost all of which were used as in-situ grafts.
Results:
Operative mortality in 138 patients undergoing bilateral ITA grafting was 1.4%, and in 108 patients undergoing unilateral ITA grafting, the rate was 0.9%. Pre-discharge angiography conducted in 97% of the subjects showed that the patency rate of all the ITA grafts (98.9%) was superior (p < 0.0001) to that of all the SV grafts (93.6%). In comparisons of survival and freedom from cardiac events at 10 years after CABG, the bilateral use of ITA grafts was proved to be more beneficial than the unilateral use (p < 0.05).
Conclusions:
It was demonstrated that bilateral ITA grafting could be performed with acceptable mortality and morbidity. Moreover, it offers better long-term survival and freedom from cardiac events than either unilateral ITA grafting or no ITA grafting. Bilateral ITA grafting thus can serve as a favorable procedure even in elderly patients.
