Age-Based Outcomes of Total Arterial Grafting

Total arterial grafting (TAG) may improve graft patency and long-term outcomes in coronary artery bypass surgery. However, the influence of age on TAG outcomes remains unclear. This study compared early complications and long-term survival in patients aged ≤60 years vs >60 years who underwent TAG.

A total of 1,876 patients who underwent TAG were retrospectively analyzed, stratified by age (≤60 years, n = 870; >60 years, n = 1006). Propensity score matching yielded 759 well-balanced pairs. Early outcomes were compared, and 27-year survival was assessed by Kaplan-Meier analysis, log-rank testing, and Cox hazards regression. Significant univariable covariates (P <.05) were entered into a multivariable model.

Older patients had more comorbidities, including diabetes, vascular disease, atrial fibrillation, renal impairment, and triple-vessel disease, but they smoked less. Rates of deep sternal wound infection and 30-day mortality were higher in older patients before matching; after matching, only wound infection remained significant (3.3% vs 1.6%; P = .046). Kaplan-Meier analysis showed superior survival in younger patients in both unmatched cohorts (χ² = 89.3; P < 2 × 10^-16) and matched cohorts (χ² = 89.3; P < 2 × 10^-16). Multivariable Cox regression identified age >60 years as an independent mortality predictor (hazard ratio, 2.436; 95% CI, 1.99-2.98; P < .001), along with previous cardiac surgery, diabetes, and previous myocardial infarction.

These findings suggest that the prognostic effect of age persists beyond operative risk, thus supporting a judicious approach to TAG in older patients while reinforcing its long-term advantage in younger cohorts. Greater emphasis on age-informed prognostic discussions and tailored postoperative care may help optimize outcomes as surgical practices evolve to accommodate an aging patient population.