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Internal thoracic artery for coronary artery grafting in octogenarians
R J Morris1, M D Strong, K E Grunewald
1Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania 19102, USA.
Insights
The left internal thoracic artery offers superior long-term survival for octogenarian coronary artery bypass grafting patients. This study demonstrates its safety and efficacy, challenging previous concerns about morbidity in elderly populations.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Vascular Grafting
Background:
- Left internal thoracic artery (LITA) grafts show superior long-term patency and survival in coronary artery bypass grafting (CABG).
- Elderly patients historically receive less frequent LITA grafts due to perceived increased risks.
- This study investigates LITA use and outcomes specifically in octogenarians (≥80 years).
Purpose of the Study:
- To evaluate the safety and efficacy of using the left internal thoracic artery (LITA) as a bypass graft in octogenarian patients undergoing coronary artery bypass grafting (CABG).
- To determine if the perceived higher morbidity and mortality associated with LITA grafting in the elderly is substantiated in the octogenarian population.
Main Methods:
- A retrospective analysis of 474 consecutive patients aged 80 years and older undergoing CABG over an 8-year period.
- Patients were divided into two groups: Group 1 (188 patients) received LITA grafts, and Group 2 (286 patients) received only saphenous vein grafts.
- Mean patient age was 82.6 years, with 65.8% males and 34.2% females.
Main Results:
- Hospital mortality was 7.8% overall. Group 1 (LITA) had a 9.0% mortality rate, while Group 2 (vein graft) had a 7.0% mortality rate.
- One-year survival rate among survivors was 6.7%.
- Long-term survival was significantly greater in the LITA group (Group 1) compared to the vein graft group (Group 2).
Conclusions:
- The left internal thoracic artery is the preferred bypass graft for octogenarian patients undergoing CABG, particularly for long-term survival benefits.
- Concerns regarding increased morbidity and mortality should not preclude the use of LITA grafts in this high-risk elderly population.
- LITA grafting should be considered the standard of care for octogenarians requiring CABG due to superior long-term outcomes.
Background:
Use of the left internal thoracic artery as a bypass graft has been shown to result in better long-term patency and improved survival. In elderly patients, the internal thoracic artery has been used less often for coronary artery bypass grafts because of the belief that greater morbidity and mortality are associated with this procedure. This study was undertaken to test this premise in the octogenarian population.
Methods:
Over an 8-year period, 474 consecutive patients 80 years of age and greater had coronary artery bypass grafting. The left internal thoracic artery was used in 188 patients (39.7%) (group 1) and saphenous vein grafts only (group 2), in 286 (60.3%). The mean age was 82.6 years (range, 80 to 95 years). There were 312 men (65.8%) and 162 women (34.2%).
Results:
Use of the internal thoracic artery as a graft has risen steadily each year, as has the number of patients who are octogenarians. The hospital mortality rate was 7.8%. Patients in group 1 had a mortality rate of 9.0% and patients in group 2, a mortality rate of 7.0%. The mortality rate among survivors at 1 year was 6.7%. Long-term survival was significantly greater in group 1.
Conclusions:
On the basis of this study, we conclude that the internal thoracic artery is the bypass graft of choice, especially in regard to long-term mortality, and should not be denied to this high-risk group.