title: Off-pump bilateral skeletonized internal thoracic artery grafting in elderly patients.
abstract: BACKGROUND
  The purpose of the present study was to compare outcome in propensity score-matched patients, aged 70 years or greater, undergoing isolated off-pump coronary bypass surgery using a bilateral (BITA) or single (SITA) skeletonized internal thoracic artery.
  
  
  METHODS
  Of 912 consecutive patients undergoing isolated coronary bypass grafting (906 using the off-pump technique without emergent conversion to cardiopulmonary bypass), the 491 aged 70 years or greater undergoing off-pump skeletonized single (n=247) or bilateral (n=244) skeletonized internal thoracic artery grafting were retrospectively analyzed after excluding the 6 who were transferred to our hospital after receiving percutaneous cardiopulmonary bypass, the 72 who had only 1 target in the left coronary area, and the 343 aged less than 70 years. A total of 217 pairs were matched using propensity scores calculated from 9 preoperative factors (0.69).
  
  
  RESULTS
  The rate of postoperative complications was similar between the groups. The 5-year estimated survival free from overall death and cardiac event, respectively, in the BITA group versus the SITA group were 86.4%±3.2% versus 73.5%±3.9% (p=0.01) and 93.2%±2.7% versus 87.5%±3.0% (p=0.01). In multivariate Cox models, bilateral internal thoracic artery grafting was significantly associated with a lower risk of overall death (hazard ratio 0.56; 95% confidence interval 0.31 to 0.99; p=0.04) and cardiac event (hazard ratio 0.36; 95% confidence interval 0.15 to 0.88; p=0.03).
  
  
  CONCLUSIONS
  In elderly patients, off-pump in situ left-sided bilateral skeletonized internal thoracic artery grafting is associated with lower risk of overall death and cardiac event than single internal thoracic artery grafting and carries no increased operative risk.
authors.affiliation: Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan. kinotake@belle.shiga-med.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Tohru
authors.initials: T
authors.lastname: Asai
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroyanagi
authors.forename: Soh
authors.initials: S
authors.lastname: Hosoba
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takashima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D024405:Gastroepiploic Artery / Q000637:transplantation; D006331:Heart Diseases / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome