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Is it safe to perform total arterial grafting in elderly patients lacking vein grafts? A single surgeon comparison
Metesh Acharya1, Habib Khan1, Sanjay Chaubey1
1Department of Cardiothoracic Surgery, King's College Hospital, London, UK.
Insights
Total arterial revascularisation (TA-CABG) is a safe and feasible alternative to conventional CABG (CO-CABG) in elderly patients, showing comparable long-term outcomes and mortality rates between the two procedures.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Vascular Grafting
Background:
- Elderly patients undergoing coronary artery bypass graft (CABG) surgery may have limited vein graft availability for conventional CABG (CO-CABG).
- The outcomes of total arterial revascularisation (TA-CABG) in this population are not fully established.
Purpose of the Study:
- To compare the short- and long-term outcomes of elderly patients (>70 years) undergoing CO-CABG versus TA-CABG.
- To evaluate in-hospital mortality, long-term mortality, and re-intervention rates.
Main Methods:
- Retrospective observational study of consecutive adult patients (>70 years) undergoing first-time CABG between 2004 and 2020.
- Analysis of primary outcomes: in-hospital mortality, long-term mortality, re-intervention rate.
- Analysis of secondary outcomes: operative duration, peri-operative complications.
Main Results:
- No significant differences in cardio-pulmonary bypass or cross-clamp durations between TA-CABG (n=46) and CO-CABG (n=145) groups.
- Comparable rates of stroke, hospital mortality, myocardial infarction, and re-intervention between the groups.
- No significant difference in long-term mortality (47% CO-CABG vs. 57% TA-CABG) or long-term survival.
Conclusions:
- TA-CABG demonstrated no significant differences in major adverse cardiac and cerebrovascular events compared to CO-CABG.
- Re-intervention rates, hospital, and long-term mortality were similar between TA-CABG and CO-CABG.
- TA-CABG is a safe and feasible alternative for elderly patients, offering comparable long-term results to CO-CABG.
Objectives:
The results of coronary artery bypass graft (CABG) surgery with total arterial revascularisation (TA-CABG) in elderly patients, who may have insufficient vein graft material for conventional CABG (CO-CABG), have not been fully established. We therefore sought to compare the short- and long-term outcomes of patients >70 years old undergoing CO-CABG and TA-CABG.
Methods:
We performed a retrospective observational study analyzing all consecutive adult patients aged >70 years undergoing first-time CABG over the 15-year period from 2004 to 2020 under a single surgeon. Primary outcomes of interest were in-hospital mortality, long-term mortality, and re-intervention rate. Secondary outcomes of interest included operative durations and the incidence of peri-operative complications.
Results:
There were 46 patients (age 76 ± 3 SD) in the TA-CABG group and 145 patients (age 76 ± 4 SD) in the CO-CABG group. Cardio-pulmonary bypass and cross-clamp durations were comparable between groups (p = .11 and p = .23, respectively). Stroke occurred in 1.0% undergoing CO-CABG compared to 0% in the TA-CABG group (p = .42). Hospital mortality was 3.0% with CO-CABG (EuroSCORE; mean [SD] 6.81 (5.81)) and 2.0% with TA-CABG (EuroSCORE; mean [SD] 6.38 (6.57)) (p = .93). On long-term follow-up, myocardial infarction occurred in 10.0% of CO-CABG patients compared to 4.0% of TA-CABG patients (p = .25). Re-intervention rates were 7% following CO-CABG, and 2% after TA-CABG (p = .23). There was no significant difference in long-term mortality between patients undergoing CO-CABG and TA-CABG (47% vs. 57%, p = .27). Long-term survival was comparable between grafting techniques (p = .27).
Conclusions:
There were no significant differences in major adverse cardiac and cerebrovascular events, re-intervention rate, hospital or long-term mortality between CO-CABG and TA-CABG. TA-CABG represents a safe and feasible alternative to CO-CABG in elderly patients offering good long-term outcomes.
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