Bilateral internal thoracic artery grafting increases long-term survival in elderly patients

Bilateral internal thoracic artery (BITA) grafting is extensively underused in coronary artery bypass graft surgery and it is mostly preserved for patients under the age of 70. The purpose of the present study was to compare outcomes in propensity score-matched patients aged 70 years or greater using a BITA, with patients using a single internal thoracic artery (SITA) graft.

Among 18 761 patients operated on in our unit until December 2006, we selected 3496 patients aged 70 years or greater; of these, 1328 received a BITA (BITA group) and 2168 received a SITA (SITA group). Propensity score matching was used to reduce the preoperative patient variability. The 3-month and 10-year survival, stroke, myocardial infarction and sternal wound complication rate (defined as sternal instability or need for refixation) were compared between the two groups.

After the correction, 892 patients per group were selected. Survival at 3 months was 90.6% in the SITA group and 91.6% in the BITA group (P = 0.34) and at 10 years was 38.9 and 57.5% (P = 0.02), respectively. The rates of stroke (1.01 vs 1.12%, P = 1), myocardial infarction (1.91 vs 2.13%, P = 0.86) and sternal wound complications (3.30 vs 5.42%, P = 0.17) were all similar between the SITA and BITA groups, respectively.

The use of BITA grafting in elderly patients improves the 10-year survival rate, with similar postoperative morbidity. Thus, using adequate selection criteria, this technique should be routinely extended also to patients older than 70 years.