Is the use of BITA vs SITA grafting safe and beneficial in octogenarians?

Background: Bilateral internal thoracic artery grafts (BITA) is questionable in

octogenarians because of shorter life expectancy and increased risk of

perioperative complications. The aim of this study was to examine the safety

and effectiveness of performing BITA and single internal thoracic artery grafts

(SITA) in patients older than 80 years.

Methods: This study compared outcome 201 consecutive octogenarians who

underwent isolated BITA grafting with those of 280 consecutive octogenarians

who underwent SITA and saphenous vein grafting during 1996-2011. Insulin

dependent diabetes, ejection fraction< 30 % and emergency operations were

more common among those who underwent SITA, and the prevalence of left

main disease was lower. Propensity score matching was used to control for

these differences, thus generating well-matched groups of 190 patients each.

Results: There were no significant differences in early mortality between the

unmatched groups: 3.2% in the BITA and 8.6% in the SITA group (p=0.12).

Rates of sternal wound infection were also similar, 1.5% versus 1.7%.

Differences were not observed in the occurrences of perioperative stroke

(3.5% versus 2.5%, p= 0.999) and myocardial infarction (1.5% versus 3.6%,

P= 0.166). The results were similar for the matched groups. Long-term

survival between the unmatched groups, and survival between the matched

groups were not significantly different.

Conclusions: This study shows equal long-term survival for BITA and SITA

grafting in octogenarians. BITA is an acceptable alternative to SITA grafting in

low-risk octogenarians and in the presence of calcified aorta or poor quality of

saphenous vein graft.