title: Is bilateral internal thoracic artery use safe in the elderly?
abstract: BACKGROUND
  The strategy of bilateral mammary artery grafting is often not considered for elderly patients due to perceived concerns of increased morbidity and mortality. The objective of this study is to explore the safety of bilateral mammary in elderly patients.
  
  
  METHODS
  Out of 7746 patients who underwent coronary artery bypass grafting using at least one internal thoracic artery (ITA), there were 3940 patients aged 65 years or greater, and of those, 3581 patients had a single ITA (SITA) and 359 patients had bilateral ITAs (BITAs). The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (MACCEs). Secondary outcomes included re-exploration for bleeding, blood transfusions, sternal wound infections, and intensive care unit and hospital length of stay.
  
  
  RESULTS
  The incidence of mortality and MACCE were similar in both groups (mortality BITA 2.6%, SITA 3.6%, p = 0.25, MACCE BITA 8.5%, SITA 6.1%, p = 0.13). Superficial and deep sternal site infections were significantly more prevalent in the BITA group than the SITA group [superficial OR 0.42, 95% CI [0.23-0.75] (p = 0.003) and deep OR 0.29, 95% CI [0.14-0.58 (p = 0.0005)].
  
  
  CONCLUSIONS
  Use of BITA is safe in the elderly with respect to mortality and early cardiovascular outcome. BITA use in the elderly is associated with an increased risk of sternal wound infection. Our experience in this situation suggests that there is a maximum age (approximately 74 years) beyond which the combined risk of MACCE and wound complications supersedes the benefits in terms of sternal infections.
authors: Ottawa Heart Institute, Ottawa, ON, Canada.
authors: Elsayed M
authors: EM
authors: Elmistekawy
authors: Nada
authors: N
authors: Gawad
authors: Michael
authors: M
authors: Bourke
authors: Thierry
authors: T
authors: Mesana
authors: Munir
authors: M
authors: Boodhwani
authors: Fraser D
authors: FD
authors: Rubens
mesh_terms: D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality / Q000639:trends; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome