Complete arterial revascularisation in patients older than 70 years.
BACKGROUND
Coronary artery bypass grafting (CABG) using left internal thoracic artery and vein grafts is standard in patients of advanced age. A number of these patients, however, present without suitable vein grafting material and thus require the use of arterial conduits. In order to investigate the safety and efficacy of complete arterial revascularisation, we have compared the perioperative results of patients older than 70 years with conventional CABG and complete arterial revascularisation.


METHODS
Group I (n = 172) with conventional CABG in 1999 was compared with 152 patients (group II) with complete arterial CABG between 1996 and July 2000. There were no significant differences regarding age, gender, left ventricular ejection fraction or incidence of three-vessel disease or left main stenosis. The proportion of reoperations was significantly higher in group II (16 %) vs. group I (4 %).


RESULTS
A mean of 3.7 +/- 0.7 anastomoses (I) versus 4.0 +/- 0.9 (II) were performed per patient (p = n. s.). Mean operating time (I: 210 +/- 46 min; II: 194 +/- 46 min) and bypass time (I: 87 +/- 25 min; II: 78 +/- 29 min) were significantly lower in group II. Ischemic time (I: 46 +/- 22 min; II: 49 +/- 21 min) was not significantly different. The incidence of sternal dehiscence was 2.9 % (I: n = 5) vs. 1.3 % (II: n = 2). Hospital mortality was 4.6 % in group I vs. 3.9 % (II).


CONCLUSIONS
Complete arterial revascularisation is a safe option in patients aged over 70. It remains to be shown whether it may also have advantage in the long term.
Nikoloudakis
N
N
Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg/Saar, Kirrberger Strasse 1, 66421 Homburg/Saar, Germany. nnniknik@aol.com
Wendler
O
O
El Dsoki
S
S
Graeter
T
T
Schäfer
H J
HJ
D000368:Aged / Q000502:physiology*; D001011:Aorta / Q000601:surgery; D002303:Cardiac Output, Low / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D016894:Endarterectomy, Carotid; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery; D016019:Survival Analysis; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures