title: Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients).
abstract: OBJECTIVE
  Ischaemic heart disease is the leading cause of death in the elderly population. Coronary artery bypass graft (CABG) surgery via sternotomy remains the standard of care for patients with multivessel coronary artery disease (CAD). Minimally invasive cardiac surgery (MICS)-CABG via left thoracotomy has been used as an alternative to sternotomy. The aim of our study was to assess the overall survival after MICS-CABG and sternotomy-CABG in elderly patients with CAD.
  
  
  METHODS
  This observational study included patients who underwent coronary bypass from 2005 to 2008. Patients 75 years and older (n = 159) were included in the final analysis. Each arm was further divided into the MICS-CABG group or sternotomy-CABG group. Primary outcome and overall survival were obtained from our records and the social security death index.
  
  
  RESULTS
  Among patients 75 years and older (159 patients), MICS-CABG had a significantly lower 5-year all-cause mortality than sternotomy-CABG (19.7 vs 47.7%, P < 0.001). Similarly, Kaplan-Meier curves showed significantly higher overall survival in the MICS-CABG group compared with sternotomy-CABG (log-rank P = 0.014). After adjusting for confounders, MICS-CABG demonstrated a lower mortality than sternotomy-CABG (HR 0.51, 95% confidence interval 0.26-0.97, P = 0.04). For patients less than 75 years old, MICS and sternotomy groups had similar survival according to both uni- and multivariate analyses.
  
  
  CONCLUSIONS
  The adjusted models demonstrated that MICS-CABG has a significantly better long-term survival than sternotomy-CABG despite slightly differing baseline characteristics. Further studies are needed to compare the short- and long-term outcomes of the two approaches among the elderly population.
authors.affiliation: Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Emad A
authors.initials: EA
authors.lastname: Barsoum
authors.affiliation: Department of Surgery, Staten Island University Hospital, Staten Island, NY, USA basemnady2000@yahoo.com.
authors.forename: Basem
authors.initials: B
authors.lastname: Azab
authors.affiliation: Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Nileshkumar
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Masood A
authors.initials: MA
authors.lastname: Shariff
authors.affiliation: Department of Cardiology, Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Lafferty
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Nabagiez
authors.affiliation: Department of Surgery, Staten Island University Hospital, Staten Island, NY, USA Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, NY, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: McGinn
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000401:mortality*; D009518:New York / Q000453:epidemiology; D056346:Sternotomy / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary artery bypass graft surgery; Coronary artery disease; Elderly; Minimally invasive cardiac surgery; Sternotomy