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Is bilateral internal thoracic artery use safe in the elderly?
Elsayed M Elmistekawy1, Nada Gawad, Michael Bourke
1Ottawa Heart Institute, Ottawa, ON, Canada.
Journal of Cardiac Surgery
|November 29, 2011
Summary
Bilateral internal thoracic artery (BITA) grafting is safe for elderly patients regarding mortality and cardiovascular events. However, it increases the risk of sternal wound infections, suggesting an age limit for its use.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Geriatric Medicine
Background:
- Bilateral internal thoracic artery (BITA) grafting is underutilized in elderly patients due to safety concerns.
- This study investigates the safety and outcomes of BITA grafting in patients aged 65 and older.
Purpose of the Study:
- To evaluate the safety of bilateral internal thoracic artery (BITA) grafting in elderly patients undergoing coronary artery bypass grafting (CABG).
- To compare the incidence of major adverse cardiac or cerebrovascular events (MACCEs) and other complications between single ITA (SITA) and BITA grafting in the elderly.
Main Methods:
- Retrospective analysis of 7746 patients undergoing CABG with at least one internal thoracic artery (ITA).
- Comparison of 359 patients with BITA versus 3581 patients with SITA, all aged 65 years or older.
- Primary outcome: MACCEs. Secondary outcomes: bleeding re-exploration, transfusions, sternal wound infections, and length of stay.
Main Results:
- Mortality and MACCE rates were similar between BITA and SITA groups (Mortality: 2.6% vs. 3.6%; MACCE: 8.5% vs. 6.1%).
- BITA grafting was associated with a significantly higher incidence of superficial and deep sternal wound infections compared to SITA grafting.
Conclusions:
- Bilateral internal thoracic artery (BITA) grafting is a safe option for elderly patients concerning mortality and early cardiovascular outcomes.
- Increased sternal wound infection risk with BITA grafting in the elderly suggests careful patient selection, potentially with an age threshold around 74 years.
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