Is total arterial myocardial revascularization with composite grafts a safe and useful procedure in the elderly?
OBJECTIVE
The aim of the study was to evaluate the mid-term results of total arterial myocardial revascularization (TAMR) with composite grafts in patients older than 70 years when compared to standard CABG technique, since the usefulness of TAMR in the elderly has not been demonstrated yet.


METHODS
A prospective randomized study was designed with the following end-points: post-operative complications, death, recurrence of angina, graft occlusion, any cardiac event and reinterventions. One hundred and eighty-eight patients older than 70 years were enrolled and assigned to Group 1(G1)=94 pts, for total arterial revascularization or Group 2(G2)=94 pts, for standard CABG (LITA on LAD plus additional saphenous veins). The groups were comparable in terms of pre-operative characteristics and Euroscore (mean: G1=8.4 vs. G2=8.2).


RESULTS
No differences between the groups were observed in terms of mean number of grafted vessels (G1=2.1 vs. G2=2.3), mean aortic cross-clamping time (G1=34+/-8 vs. G2=33+/-6min), mechanical ventilation time (G1=23+/-4 vs. G2=22+/-4hr), ICU stay (G1=40+/-10 vs. G2=39+/-9hr), post-operative complications and hospital mortality (G1=5.3% vs. G2=4.2%). At a mean follow-up of 12+/-4 months, cumulative incidence of angina recurrence was 2.1% in G1 vs. 11% in G2 (P=0.021). Angiographic evaluation showed 98.2% arterial patency in G1 vs. 86% saphenous vein graft patency in G2 (P<0.001). Multivariate analysis identified conventional CABG surgery as independent predictor of angina recurrence, graft occlusion and late cardiac events.


CONCLUSIONS
Total arterial revascularization with composite grafts proved to be a safe and effective procedure also in the elderly. Composite arterial grafts provided superior clinical outcome with a lower rate of angina recurrence, graft occlusion and late cardiac events when compared to conventional CABG strategy.
Muneretto
Claudio
C
Department of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy. munerett@master.cci.unibs.it
Negri
Alberto
A
Bisleri
Gianluigi
G
Manfredi
Jacopo
J
Terrini
Alberto
A
Metra
Marco
M
Nodari
Savina
S
Cas
Livio Dei
LD
D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D012044:Regression Analysis; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome