Bilateral internal thoracic artery grafting in elderly patients: Any benefit in survival?
Daniel Navia1, Juan Espinoza1, Mariano Vrancic1
1Cardiac Surgery Department, Instituto Cardiovascular, Buenos Aires, Argentina.
Insights
Bilateral internal thoracic artery (BITA) grafts significantly improve 10-year survival in patients over 70 undergoing coronary artery bypass grafting. This surgical approach offers better long-term outcomes with similar postoperative complication rates compared to single internal thoracic artery grafts.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Geriatric Cardiology
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Graft selection, particularly the use of internal thoracic arteries (ITAs), is crucial for long-term graft patency and patient survival.
- The efficacy of bilateral internal thoracic artery (BITA) grafting versus single internal thoracic artery (SITA) grafting in elderly patients (≥70 years) remains a subject of investigation.
Purpose of the Study:
- To compare long-term survival outcomes between elderly patients (≥70 years) who received BITA grafts versus SITA grafts for isolated CABG.
- To evaluate the impact of BITA grafting on postoperative complications in this patient cohort.
Main Methods:
- A retrospective study identified 1300 patients aged ≥70 years who underwent isolated CABG between 2001 and 2018.
- Patients were divided into two groups: 968 receiving BITA grafts and 332 receiving SITA grafts.
- Propensity score matching was employed to create comparable groups, and 10-year survival and postoperative complications were analyzed.
Main Results:
- Crude 10-year survival was significantly higher in the BITA group (67.0% ± 2.5%) compared to the SITA group (56.0% ± 3.4%, P < .016).
- Propensity score-matched analysis confirmed superior actuarial survival for BITA recipients (66.0% ± 5.3%) versus SITA recipients (53.0% ± 3.9%, HR 0.64, P = .022).
- Postoperative complication rates were comparable between the BITA and SITA groups.
Conclusions:
- BITA grafting in patients aged 70 years and older is associated with improved 10-year survival compared to SITA grafting.
- The BITA technique demonstrates similar postoperative morbidity, suggesting a favorable risk-benefit profile for elderly patients.
- Increased consideration of BITA grafting in older patients undergoing CABG may enhance long-term survival benefits.
Objective:
The purpose of the present study was to compare survival outcomes in propensity score-matched patients aged 70 years or greater receiving a bilateral internal thoracic artery graft with patients receiving a single internal thoracic artery graft.
Methods:
Among 4083 consecutive patients with isolated coronary artery bypass grafting who underwent operation between January 2001 and December 2018, we identified 1300 patients aged 70 years or greater; of these, 968 received a bilateral internal thoracic artery (bilateral internal thoracic artery group) and 332 received a single internal thoracic artery (single internal thoracic artery group). Propensity score matching was used to reduce the preoperative patient differences. The 10-year survival and postoperative complications were compared between the 2 groups.
Results:
A Kaplan-Meier curve at 10 years of follow-up showed that crude survival was significantly superior in patients with bilateral internal thoracic artery grafts than in patients with single internal thoracic artery grafts (67.0% ± 2.5% vs 56.0% ± 3.4%, respectively; P < .016). In the actuarial survival, estimates for propensity score-matched patients with a bilateral internal thoracic artery showed a significantly higher rates of survival than patients with a single internal thoracic artery by the end of follow-up (66.0% ± 5.3% vs 53.0% ± 3.9%, respectively; hazard ratio, 0.64; 95% confidence interval, 0.44-0.94; P = .022, univariable Cox Model and multivariable analysis hazard ratio, 0.66; 95% confidence interval, 0.45-0.97; P = .036 Cox model). Postoperative complications were all similar between the single internal thoracic artery and bilateral internal thoracic artery groups.
Conclusions:
The use of bilateral internal thoracic artery grafting in older patients improves 10-year survival, with similar postoperative morbidity. This surgical technique might have beneficial effects in survival in patients aged more than 70 years. Its use could be considered more frequently.
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