title: Short term outcomes of total arterial coronary revascularization in patients above 65 years: a propensity score analysis.
abstract: BACKGROUND
  Despite the advantages of bilateral mammary coronary revascularization, many surgeons are still restricting this technique to the young patients. The objective of this study is to demonstrate the safety and potential advantages of bilateral mammary coronary revascularization in patients older than 65 years.
  
  
  METHODS
  Group I included 415 patients older than 65 years with exclusively bilateral mammary revascularization. Using a propensity score we selected 389 patients (group II) in whom coronary bypass operations were performed using the left internal mammary artery and the great saphenous vein.
  
  
  RESULTS
  The incidence of postoperative stroke was higher in group II (1.5% vs. 0%, P = 0.0111). The amount of postoperative blood loss was higher in group I (908 +/- 757 ml vs. 800 +/- 713 ml, P = 0.0405). There were no other postoperative differences between both groups.
  
  
  CONCLUSIONS
  Bilateral internal mammary artery revascularization can be safely performed in patients older than 65 years. T-graft configuration without aortic anastomosis is particularly beneficial in this age group since it avoids aortic manipulation, which is an important risk factor for postoperative stroke.
authors.affiliation: Cardiac Surgery Department, Heart Institute Lahr/Baden, Germany. waelhassanein@yahoo.com
authors.forename: Wael
authors.initials: W
authors.lastname: Hassanein
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: Hegazy
authors.forename: Alexander
authors.initials: A
authors.lastname: Albert
authors.forename: Ina C
authors.initials: IC
authors.lastname: Ennker
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rosendahl
authors.forename: Stefan
authors.initials: S
authors.lastname: Bauer
authors.forename: Juergen
authors.initials: J
authors.lastname: Ennker
mesh_terms: D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects; D008297:Male; D011183:Postoperative Complications; D057216:Propensity Score; D012501:Saphenous Vein / Q000637:transplantation; D020521:Stroke / Q000209:etiology
references.citation: Ann Thorac Surg. 2008 Dec;86(6):1861-5
references.pmid: 19021996
references.citation: Eur J Cardiothorac Surg. 2004 Sep;26(3):542-8
references.pmid: 15302049
references.citation: Eur J Cardiothorac Surg. 2009 Jan;35(1):191
references.pmid: 19027319
references.citation: Circulation. 2001 Oct 30;104(18):2152-4
references.pmid: 11684622
references.citation: Infect Control Hosp Epidemiol. 1999 Apr;20(4):250-78; quiz 279-80
references.pmid: 10219875
references.citation: Thorac Cardiovasc Surg. 1990 Apr;38(2):123-34
references.pmid: 2190348
references.citation: Eur J Cardiothorac Surg. 2006 Aug;30(2):318-23
references.pmid: 16829096
references.citation: Interact Cardiovasc Thorac Surg. 2007 Dec;6(6):787-91
references.pmid: 17704121
references.citation: Ann Thorac Surg. 2005 Jul;80(1):144-8
references.pmid: 15975357
references.citation: Ann Thorac Surg. 1999 Nov;68(5):1619-22
references.pmid: 10585030
references.citation: Ann Thorac Surg. 1999 Jun;67(6):1637-42
references.pmid: 10391267
references.citation: Ann Thorac Surg. 2007 Mar;83(3):1008-14; discussion 1014-5
references.pmid: 17307450
references.citation: J Thorac Cardiovasc Surg. 2002 Jan;123(1):8-15
references.pmid: 11782750
references.citation: Ann Thorac Surg. 1997 May;63(5):1262-7
references.pmid: 9146312
references.citation: Ann Thorac Surg. 2004 Dec;78(6):2005-12; discussion 2012-4
references.pmid: 15561021
references.citation: Thorac Cardiovasc Surg. 2008 Dec;56(8):461-6
references.pmid: 19012210
references.citation: Eur J Cardiothorac Surg. 2008 Jun;33(6):977-82
references.pmid: 18448349
references.citation: Ann Thorac Surg. 2001 Aug;72(2):450-5
references.pmid: 11515881
references.citation: Eur J Cardiothorac Surg. 2003 May;23(5):657-64; discussion 664
references.pmid: 12754014