title: Bilateral internal thoracic artery grafting in octogenarians: where are the benefits?
abstract: The use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization is usually discouraged in the very elderly because of increased risk of perioperative complications. The aim of the study was to analyze early and late outcomes of BITA grafting in octogenarians. From January 1999 throughout February 2014, 236 consecutive octogenarians with multivessel coronary artery disease underwent primary isolated coronary bypass surgery at the authors' institution. Six of these patients underwent emergency surgery and were excluded from this retrospective study; consequently, 135 BITA patients were compared with 95 single internal thoracic artery (SITA) patients according to early and late outcomes. Between BITA and SITA patients, there was no significant difference in the operative risk (EuroSCORE II: 8 ± 7.7 vs. 7.6 ± 6.1 %, p = 0.65). There was a lower aortic manipulation in BITA patients. Hospital mortality (3 vs. 4.2 %, p = 0.44) and perioperative complications were similar except that only BITA patients experienced sternal wound infection (5.2 %, p = 0.022). The mean follow-up was 4.7 ± 3.3 years. There were no differences between the two groups in overall survival (p = 0.79), freedom from cardiac and cerebrovascular deaths (p = 0.73), major adverse cardiac and cerebrovascular events (p = 0.63) and heart failure hospital readmission (p = 0.64). Predictors of decreased late survival were diabetes (p = 0.0062) and congestive heart failure (p = 0.0004). BITA grafting can be routinely used in octogenarians with atherosclerotic ascending aorta without an increase in hospital mortality or major adverse cardiac and cerebrovascular complications. However, there is an increased risk of sternal wound infection without a demonstrable long-term benefit.
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. gius.gatti@gmail.com.|Division of Cardiac Surgery, Ospedale di Cattinara, via P. Valdoni, 7, 34148, Trieste, Italy. gius.gatti@gmail.com.
authors: Giuseppe
authors: G
authors: Gatti
authors: Division of Cardiology, Ospedali Riuniti, Trieste, Italy.
authors: Luca
authors: L
authors: Dell'Angela
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Bernardo
authors: B
authors: Benussi
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Lorella
authors: L
authors: Dreas
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Gabriella
authors: G
authors: Forti
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Marco
authors: M
authors: Gabrielli
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Elisabetta
authors: E
authors: Rauber
authors: Division of Infective Diseases, Ospedali Riuniti, Trieste, Italy.
authors: Roberto
authors: R
authors: Luzzati
authors: Division of Cardiology, Ospedali Riuniti, Trieste, Italy.
authors: Gianfranco
authors: G
authors: Sinagra
authors: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors: Aniello
authors: A
authors: Pappalardo
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000401:mortality; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Arterial grafts; Coronary artery bypass grafts; Geriatric; Off-pump surgery; Outcomes; Sternal wound infection