Benjamin Medalion1, Rephael Mohr2, Ynai Ben-Gal3, Nachum Nesher3, Amir Kramer3, Shimrit Eliyahu4, Dmitry Pevni3. 1. Department of Cardiothoracic Surgery, Rabin Medical Center, Petach Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: pevnid@gmail.com. 3. Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
OBJECTIVES: Bilateral internal thoracic artery grafting in elderly patients is controversial. We compared the outcome of bilateral internal thoracic artery grafting with that of single internal thoracic artery and saphenous vein and radial artery conduits in these patients. METHODS: Patients aged 70 years or more who underwent bilateral internal thoracic artery grafting between 1996 and 2008 (n = 1045) were compared with patients who underwent coronary artery bypass grafting with a single internal thoracic artery + saphenous vein graft (n = 582) or a single internal thoracic artery + radial artery (n = 249). RESULTS: Prevalence of female gender, diabetes, emergency operation, and chronic obstructive pulmonary disease was lower in the bilateral internal thoracic artery grafting group compared with the internal thoracic artery + radial artery and internal thoracic artery + saphenous vein graft groups, whereas congestive heart failure and recent myocardial infarction were more prevalent in the bilateral internal thoracic artery grafting group. Operative mortality and sternal wound infections were not significantly different between groups. The mean follow-up was 8.17 ± 4.45 years. Ten-year survival (Kaplan-Meier) in the internal thoracic artery + saphenous vein graft group was significantly lower than in the bilateral internal thoracic artery grafting and internal thoracic artery + radial artery groups (P < .001). Assignment to the saphenous vein graft group was also associated with decreased adjusted survival (P < .001) compared with the bilateral internal thoracic artery and internal thoracic artery + radial artery groups. CONCLUSIONS: This study supports the use of arterial grafts in elderly patients undergoing coronary artery bypass grafting.
OBJECTIVES: Bilateral internal thoracic artery grafting in elderly patients is controversial. We compared the outcome of bilateral internal thoracic artery grafting with that of single internal thoracic artery and saphenous vein and radial artery conduits in these patients. METHODS:Patients aged 70 years or more who underwent bilateral internal thoracic artery grafting between 1996 and 2008 (n = 1045) were compared with patients who underwent coronary artery bypass grafting with a single internal thoracic artery + saphenous vein graft (n = 582) or a single internal thoracic artery + radial artery (n = 249). RESULTS: Prevalence of female gender, diabetes, emergency operation, and chronic obstructive pulmonary disease was lower in the bilateral internal thoracic artery grafting group compared with the internal thoracic artery + radial artery and internal thoracic artery + saphenous vein graft groups, whereas congestive heart failure and recent myocardial infarction were more prevalent in the bilateral internal thoracic artery grafting group. Operative mortality and sternal wound infections were not significantly different between groups. The mean follow-up was 8.17 ± 4.45 years. Ten-year survival (Kaplan-Meier) in the internal thoracic artery + saphenous vein graft group was significantly lower than in the bilateral internal thoracic artery grafting and internal thoracic artery + radial artery groups (P < .001). Assignment to the saphenous vein graft group was also associated with decreased adjusted survival (P < .001) compared with the bilateral internal thoracic artery and internal thoracic artery + radial artery groups. CONCLUSIONS: This study supports the use of arterial grafts in elderly patients undergoing coronary artery bypass grafting.
Authors: Mario Gaudino; Antonino Di Franco; Mohamed Rahouma; Derrick Y Tam; Mario Iannaccone; Saswata Deb; Fabrizio D'Ascenzo; Ahmed A Abouarab; Leonard N Girardi; David P Taggart; Stephen E Fremes Journal: J Am Heart Assoc Date: 2018-01-06 Impact factor: 5.501
Authors: Mario Gaudino; Faisal Bakaeen; Umberto Benedetto; Mohamed Rahouma; Antonino Di Franco; Derrick Y Tam; Mario Iannaccone; Thomas A Schwann; Robert Habib; Marc Ruel; John D Puskas; Joseph Sabik; Leonard N Girardi; David P Taggart; Stephen E Fremes Journal: J Am Heart Assoc Date: 2018-05-17 Impact factor: 5.501