title: Completeness of revascularization and survival among octogenarians with triple-vessel disease.
abstract: BACKGROUND
  We sought to determine the impact of the completeness of surgical revascularization among octogenarians with triple-vessel disease.
  
  
  METHODS
  Between 1992 and 2008, 476 consecutive patients aged 80 years or more who underwent primary isolated coronary artery bypass grafting (CABG) procedures were identified. Early and late survival were compared among patients who underwent complete revascularization (CR, n=391) and incomplete revascularization (IR, n=85). IR was present when 1 or more of the 3 main coronary arteries with 50% or greater stenosis that were identified preoperatively as a surgical target by the operating surgeon were not grafted. The mean follow-up was 5.4±3.0 years (maximum 15.3 years).
  
  
  RESULTS
  Baseline risk was similar between the 2 groups of patients. IR was more frequent in off-pump compared with on-pump CABG (34.9% versus 16.2%, respectively; p=0.002). The most common reason for IR was small or severely diseased arteries (87%). The incidence of postoperative myocardial infarction (MI) was similar in both groups (CR, 18.4% versus IR, 17.3%; p=0.81). In-hospital mortality was 7.2% among patients with CR and 4.7% among patients with IR (p=0.60). Three, 5-, and 8-year freedom from all-cause mortality among patients who underwent CR were 89.2%, 74.1%, and 54.3%, respectively, and were not significantly different from those patients who underwent IR (86.6%, 74.5%, and 49.4%, respectively) (p=0.40).
  
  
  CONCLUSIONS
  In octogenarians with triple-vessel disease, a strategy of incomplete revascularization during CABG does not negatively impact early or long-term survival.
authors.affiliation: Department of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada. siamak.mohammadi@fmed.ulaval.ca
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Dimitri
authors.initials: D
authors.lastname: Kalavrouziotis
authors.forename: Francois
authors.initials: F
authors.lastname: Dagenais
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.forename: Eric
authors.initials: E
authors.lastname: Charbonneau
mesh_terms: D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011792:Quebec; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome