Survival benefit from a second arterial conduit to the circumflex circulation persists in elderly after coronary
Suvitesh Luthra1, Miguel M Leiva-Juárez2, Pietro G Malvindi1
1Division of Cardiac Surgery, University Hospital Southampton, Hampshire, UK.
Insights
A second arterial graft provides a survival benefit in coronary artery bypass surgery across all age groups. While the benefit gradually declines with age, elderly patients should still be considered for this procedure.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Geriatric Cardiology
Background:
- Investigating the impact of patient age on the survival benefits of using a second arterial conduit in coronary artery bypass grafting (CABG).
- Focus on grafts to the left-sided circulation, specifically the circumflex artery territory.
Purpose of the Study:
- To determine if age influences the survival advantage of using a second arterial conduit versus a venous graft in CABG.
- To analyze the relationship between age and the effectiveness of arterial grafts in the circumflex territory.
Main Methods:
- Retrospective analysis of isolated CABG data from October 2004 to March 2014.
- Included patients with a left internal mammary artery (LIMA) graft to the LAD and an additional arterial or venous graft to the circumflex system.
- Propensity matching used to balance covariates and compare outcomes between arterial and venous second conduits.
Main Results:
- No significant difference in in-hospital mortality between arterial (1.12%) and venous (1.24%) grafts.
- Overall 10-year survival was significantly higher with arterial grafts (82.6%) compared to venous grafts (74.6%).
- Propensity matching of 1226 patients revealed a linear decrease in the survival benefit of a second arterial graft with increasing age.
Conclusions:
- The survival advantage of a second arterial graft in CABG persists across all age groups.
- A gradual decline in survival benefit is observed with increasing age, but age alone should not preclude elderly patients from receiving a second arterial graft.
- Recommends considering arterial grafts for the circumflex circulation in elderly patients to maximize long-term survival benefits.
Background:
This retrospective propensity matched study investigated the impact of age on the survival benefit from a second arterial conduit to the left-sided circulation.
Methods:
Data for isolated coronary artery bypass surgery were collected from October 2004 to March 2014. All patients with an internal mammary artery graft to left anterior descending artery and additional arterial or venous graft to the circumflex circulation were included. Propensity matching was used to balance co-variates and generate odds of death for each observation. Odds ratios (venous vs. arterial) were charted against age.
Results:
The in-hospital mortality rate was 1.12% (arterial) vs. 1.24% (venous) (p = 0.77). The overall 10-year survival was 74.6% (venous) vs. 82.6% (arterial) (p = 0.001). A total of 1226 patients were successfully matched to the venous or arterial (second conduit to circumflex territory after left internal mammary artery to left anterior descending artery) cohorts. Odds ratio for death (venous to arterial) showed a linear decremental overall survival benefit for the second arterial graft to circumflex circulation with increasing age.
Conclusions:
The survival benefit of a second arterial graft persists through all age groups with a gradual decline with increasing age over the decades. Elderly patients should not be denied a second arterial graft to the circumflex circulation based on age criterion alone.
