Arterial coronary artery bypass grafting is safe and effective in elderly patients
Benjamin Medalion1, Rephael Mohr2, Ynai Ben-Gal2
1Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Bilateral internal thoracic artery grafts show superior long-term survival in elderly patients undergoing coronary artery bypass grafting compared to single internal thoracic artery with saphenous vein grafts. Arterial grafts are recommended for this patient group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Vascular Grafting
Background:
- Bilateral internal thoracic artery (BITA) grafting in elderly patients (≥70 years) remains controversial.
- Comparison of BITA versus single internal thoracic artery (SITA) with other conduits is crucial for optimizing outcomes in this demographic.
Purpose of the Study:
- To compare the long-term outcomes of BITA grafting versus SITA with saphenous vein graft (SVG) or radial artery (RA) conduits in elderly patients undergoing coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective comparison of 1045 elderly patients undergoing BITA grafting (1996-2008) with 582 patients receiving SITA+SVG and 249 patients receiving SITA+RA.
- Analysis included patient demographics, comorbidities, operative characteristics, and long-term survival using Kaplan-Meier estimates.
Main Results:
- While baseline characteristics varied, operative mortality and sternal wound infections were similar across groups.
- Ten-year survival was significantly higher in the BITA and SITA+RA groups compared to the SITA+SVG group (P < .001).
- Adjusted survival analysis confirmed poorer outcomes associated with SVG use compared to arterial grafts.
Conclusions:
- Arterial conduits, particularly BITA grafting, demonstrate superior long-term survival benefits in elderly patients undergoing CABG.
- The findings support the use of arterial grafts over saphenous vein grafts in this high-risk population.
Objectives:
Bilateral internal thoracic artery grafting in elderly patients is controversial. We compared the outcome of bilateral internal thoracic artery grafting with that of single internal thoracic artery and saphenous vein and radial artery conduits in these patients.
Methods:
Patients aged 70 years or more who underwent bilateral internal thoracic artery grafting between 1996 and 2008 (n = 1045) were compared with patients who underwent coronary artery bypass grafting with a single internal thoracic artery + saphenous vein graft (n = 582) or a single internal thoracic artery + radial artery (n = 249).
Results:
Prevalence of female gender, diabetes, emergency operation, and chronic obstructive pulmonary disease was lower in the bilateral internal thoracic artery grafting group compared with the internal thoracic artery + radial artery and internal thoracic artery + saphenous vein graft groups, whereas congestive heart failure and recent myocardial infarction were more prevalent in the bilateral internal thoracic artery grafting group. Operative mortality and sternal wound infections were not significantly different between groups. The mean follow-up was 8.17 ± 4.45 years. Ten-year survival (Kaplan-Meier) in the internal thoracic artery + saphenous vein graft group was significantly lower than in the bilateral internal thoracic artery grafting and internal thoracic artery + radial artery groups (P < .001). Assignment to the saphenous vein graft group was also associated with decreased adjusted survival (P < .001) compared with the bilateral internal thoracic artery and internal thoracic artery + radial artery groups.
Conclusions:
This study supports the use of arterial grafts in elderly patients undergoing coronary artery bypass grafting.
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