Should bilateral internal thoracic artery grafting be used in elderly patients undergoing coronary artery bypass grafting?
BACKGROUND
Although bilateral internal thoracic artery grafting is associated with improved survival, the use of this technique in the elderly is controversial because of their increased surgical risk and shorter life expectancy. The purpose of this study was to evaluate the effect of age on outcome of patients undergoing bilateral internal thoracic artery grafting.


METHODS AND RESULTS
Between 1996 and 2001, 1714 consecutive patients underwent skeletonized bilateral internal thoracic artery grafting, of whom 748 were ≤65 years of age, 688 were between 65 and 75 years of age, and 278 were ≥75 years of age. Operative mortality of the 3 age groups (1.2%, 4.1%, and 5.8%, respectively) was lower than the logistic EuroSCORE predicted mortality (3.9%, 6.5%, and 9.3%, respectively; P<0.001). There were no significant differences among the groups in occurrence of sternal infection (1.3%, 2.6%, and 1.4%, respectively; P=0.171). Mean follow-up was 11.5 years. Kaplan-Meier 10-year survival for patients ≤65, 65 to 75, and >75 years of age was 85%, 65%, and 40%, respectively (P<0.001). These rates were better than the corresponding predicted Charlson Comorbidity Index survival rates (68%, 37%, and 20%, respectively; P<0.001 for all age groups), approaching survival of the sex- and age-matched general population (90%, 70%, and 41%, respectively). Age ≤65 years (hazard ratio, 0.232; 95% confidence interval, 0.188-0.288) and age 65 to 75 years (hazard ratio, 0.499; 95% confidence interval, 0.414-0.602) were independent predictors of improved survival (Cox model).


CONCLUSIONS
Bilateral internal thoracic artery grafting should be considered in patients >65 years of age because of the significant survival benefit obtained with this surgical technique with no additional risk of sternal wound infection related to age.
['Medalion|Benjamin|B|', 'Mohr|Rephael|R|', 'Frid|Osnat|O|', 'Uretzky|Gideon|G|', 'Nesher|Nachum|N|', 'Paz|Yosef|Y|', 'Kramer|Amir|A|', 'Pevni|Dmitry|D|']
D017677:Age Distribution D000368:Aged D000369:Aged, 80 and over D015897:Comorbidity D001026:Coronary Artery Bypass D005260:Female D005500:Follow-Up Studies D006801:Humans D007557:Israel D053208:Kaplan-Meier Estimate D008297:Male D008323:Mammary Arteries D008875:Middle Aged D015999:Multivariate Analysis D016016:Proportional Hazards Models D012042:Registries D012189:Retrospective Studies D012307:Risk Factors D013530:Surgical Wound Infection D016896:Treatment Outcome
cardiopulmonary bypass myocardial revascularization surgery transplantation