Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients: a prospective randomized evaluation.
OBJECTIVE
The technique of choice for myocardial revascularization in elderly patients remains a debated issue. We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients.


METHODS
We prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization. Patients were assigned at random to group 1, 80 patients undergoing total arterial revascularization (left internal thoracic artery on left anterior descending coronary artery plus radial artery), or group 2, 80 patients undergoing standard coronary artery bypass graft surgery (left internal thoracic artery on left anterior descending coronary artery plus saphenous veins). The radial artery was used in all cases as a composite Y-graft.


RESULTS
Preoperative characteristics and risk factors (EuroSCORE: group 1 = 7.9 vs group 2 = 8.1), number of grafted coronary vessels (group 1 = 2.4 vs group 2 = 2.5), aortic crossclamping time (group 1 = 37 +/- 7 minutes vs group 2 = 38 +/- 7 minutes), ventilation time (group 1 = 22 +/- 12 hours vs group 2 = 23 +/- 11 hours), intensive care unit stay (group 1 = 39 +/- 10 hours vs group 2 = 40 +/- 9 hours), and hospital mortality (group 1 = 3.8% vs group 2 = 5%) were comparable between the groups. Comparison between the 2 groups in terms of early postoperative complications showed a higher incidence of cerebrovascular accidents in group 2 (group 1 = 0 patients vs group 2 = 4 patients, 5%). At a mean follow-up of 16 +/- 3 months, patients in group 1 showed superior clinical results with a lower incidence of graft occlusion (group 1 = 2 vs group 2 = 11; P =.06) and angina recurrence (group 1 = 2 patients vs group 2 = 12 patients; P =.03). Multivariate analysis identified saphenous vein grafts as independent predictors for graft occlusion and angina recurrence.


CONCLUSIONS
Left internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients. It improved the clinical outcome, providing a significantly higher graft patency rate and a lower incidence of late cardiac events.
Muneretto
Claudio
C
Division of Cardiac Surgery, University of Brescia Medical School, Italy. munerett@master.cci.unibs.it
Bisleri
Gianluigi
G
Negri
Alberto
A
Manfredi
Jacopo
J
Carone
Enrico
E
Morgan
Jeffrey A
JA
Metra
Marco
M
Dei Cas
Livio
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000379:methods; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017534:Radial Artery / Q000637:transplantation*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013895:Thoracic Arteries / Q000637:transplantation*; D016896:Treatment Outcome