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Updated: Aug 5, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Impact of Graft Strategies on the Outcome of Octogenarians Undergoing Coronary Artery Bypass Grafting
Nicolai Bayer1, Michael Schmoeckel1, Peter Wohlmuth2
1Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
Insights
Bilateral internal thoracic artery grafting improves survival and outcomes in octogenarians with multivessel disease. Emergency operations and comorbidities negatively impact survival in this patient group.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for multivessel coronary artery disease.
- Octogenarians represent a growing population undergoing complex cardiac procedures, necessitating tailored surgical strategies.
- Optimizing outcomes in elderly patients with extensive coronary disease remains a significant clinical challenge.
Purpose of the Study:
- To evaluate the efficacy of CABG in octogenarians with multivessel coronary artery disease.
- To assess the impact of different graft strategies, specifically bilateral internal thoracic artery (BITA) use, on patient outcomes.
- To identify factors influencing survival and the need for reintervention in this elderly cohort.
Main Methods:
- A retrospective analysis of 225 octogenarian patients (median age 82.1 years) who underwent CABG for multivessel disease between 2014 and 2020.
- Survival prediction and need for coronary reintervention were analyzed.
- The logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was utilized for outcome assessment.
Main Results:
- Overall survival at a mean follow-up of 3.3 years was 76.4%.
- Emergency operation, advanced age, chronic pulmonary disease, and reduced renal or ventricular function were associated with poorer survival.
- BITA grafting demonstrated a 1.7-fold improvement in the combined outcome of survival and need for coronary reintervention (p=0.024).
- Off-pump CABG showed no significant impact on survival.
Conclusions:
- BITA grafting is associated with normalized survival and improved outcomes in octogenarians with multivessel coronary artery disease.
- Emergency surgical conditions, pulmonary disease, and impaired renal or ventricular function are predictors of adverse outcomes.
- Risk stratification using logistic EuroSCORE is effective for predicting long-term outcomes in this population.
Purpose:
To analyse the outcome of coronary artery bypass grafting (CABG) in octogenarians with coronary multivessel disease and the impact of different graft strategies and other factors.
Methods:
Out of 1654 patients with multivessel disease who underwent CABG at our institution between January 2014 and March 2020, we investigated 225 consecutive patients with a median age of 82.1 years for survival prediction and need for coronary reintervention; a detailed outcome analysis was performed.
Results:
At mean follow-up of 3.3 years, the overall survival was 76.4%. An indication for emergency operation (p = 0.002), age (p <0.001), chronic pulmonary disease (p = 0.024), and reduced renal or ventricular function (p <0.001) had the highest impact on limited survival. The combination outcome of survival and coronary reintervention was 1.7-fold improved (p = 0.024) after use of the bilateral internal thoracic artery (BITA) (66.2%). Off-pump CABG (12%) revealed no impact on survival. Smokers showed a poorer outcome (p = 0.004). The logistic European System for Cardiac Operative Risk Evaluation was highly effective for evaluating long-term outcomes (p <0.001).
Conclusions:
BITA grafting normalizes survival and reveals a better outcome in octogenarians with multivessel disease. However, patients at risk of poorer survival were operated under emergency conditions and those with pulmonary disease and reduced ventricular or renal function.
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