Safety of BIMA grafting in elderly patients above 75 years old

Background: the benefits of bilateral internal mammary (BIMA) as conduits of choice are well documented. Previous studies recommended the use of BIMA in patient younger than 70 years old. In this study we examined our results for BIMA grafting in elderly patients (above 75 years old)

Methods: Between 2006 and 2015 we preformed 1752 BIMA CABGs which 103 of them were above 75 years old . Average age, female gender, euroscore and hypertension were higher in the elderly group ( 77 ± 2.74 versus 58.9 ±8.2 years old; p<0.01, 21.78% versus 12.58% females; p=0.03, 10.9 versus 3.92 euroscore; P<0.01 and 85% versus 65% hypertensive patients; p<0.01). No significant differences regarding BMI (27.06 ± 4.5 versus 28.7 ± 4.15 kg/m2; P = .58), diabetes mellitus (41% versus 41%; P = 1) and fraction of patient with severe LV dysfunction (10.9% versus 12.51%; P = .6).

Results: No remarkable differences were noticed between the two groups regarding the number of distal anastomoses (3.72 ± 09 versus 3.78 ± 1; P = .48), total operation time (215 ± 25.06 versus 210 ± 35 min; P = .7), postoperative stroke (2.97% versus 0.72%; P = .2), myocardial infarction (0% versus 0.18%; P = .8) and postoperative atrial fibrillation ( 20.79 % versus 20.48%; P=.95). Re-exploration because of bleeding was more common in the elderly patient group ( 6.9% versus 2.43% ; p=0.05), further more , deep sternal wound infection was significantly higher in the elderly group ( 4.8% versus 1.03% ; p= 0.02). No significant difference in 30-day mortality was found (1.98% versus 0.79%; P = 0.41).

Conclusion: In our experience BIMA grafting in patient above 75 years old is possible and safe but consideration need to be taken because of higher rates of sternal wound infection and higher re exploration rate.