Intraoperative behavior of arterial grafts in the elderly and the young: a flowmetric systematic analysis

Extensive arterial grafting (Art-CABG) in the elderly is still questioned due to the reduced life expectancy and the supposed higher periprocedural risk. Reports further demonstrated accelerated atherosclerosis of arterial grafts in the elderly, with hampered short-term and long-term results. We reviewed our experience of patients undergoing Art-CABG between January 2003 and January 2007, divided into two groups: the elderly (238 patients > or = 70 years; Group A) and the young (195 patients < or = 60 years; Group B). Transit time flowmetric (TTF) maximum and mean flow, pulsatility index (PI), and graft flow reserve (GFR) were compared. Hospital outcome was analyzed. Hospital mortality, need for intra-aortic balloon pump, troponin I, and echocardiographic segmental kinetics were comparable between the two groups (P = not significant [NS]). Stratifying patients for target vessels and type of arterial CABG, no differences in TTF results were recorded between the two groups either on-pump (P = NS) and off-pump (P = NS), both for the two internal mammary arteries (P = NS irrespective of the target vessel) and the radial artery conduits (P = NS irrespective of the target vessel). Although graft flow reserve was significantly recruited in all patients (P < 0.05 in young and elderly, either on-pump and off-pump, irrespective of the arterial conduit and the grafted vessel), GFR of all arterial grafts was comparable between elderly and young patients, either on-pump (P = NS) or off-pump (P = NS). Art-CABG showed similar TTF results in elderly and young patients, regardless of the arterial conduit, target vessel, or surgical technique employed. These functional results supported the reported survival benefit of arterial revascularization in the elderly.