Objectives: Bilateral Internal Thoracic Artery (ITA) grafting in the elderly is controversial because of their shorter life expectancy , and the excellent survival benefit obtained with single ITA. The purpose of this study is to compare outcome of bilateral ITA(BITA) grafting to that of single ITA and other conduits, such as saphenous veins(SVG) or radial artery(RA) ,in the subset of elderly patients.
Methods and Results: One thousand and fourty five patients 70 years old or older who underwent BITA grafting between 1996 and 2008 were compared with 582 patients who underwent CABG with single ITA and SVG and 249 patients who underwent CABG with single ITA and RA.
Occurrence of female gender (27% versus 42% and 34% , in the B ITA, RA and SVG groups respectively) diabetes (32.% vs 42%and 38%) emergency operation (16% vs. 20% and 25%) and COPD (6% vs.15% and 13%) was lower in the BITA group. On the other hand CHF (24% vs. 14% and 18%) and recent MI (25% vs 12% and 18%) were more prevalent among BITA patients. . In order to account for differences between groups in preoperative characteristics multivariate analyses defined predictors of early and late mortality after forcing propensity score with patients` characteristics into the models.
Operative mortality (3.7% vs 3.2% and 3.3%) and sternal wound infections (1.7% vs. 0.8% and 1.9%) were not significantly different between groups
Mean follow –up was 8.17+ 4.45 years. Ten year survival (Kaplan-Meier ) of the SVG group was significantly lower . ( 45% versus 56% and 54% in the BITA and RA groups respectively, p< 0.001, log rank test,) Assignment to the SVG group was also associated with decreased adjusted survival (H.R. 1.21, 95% confidence interval: 1.04 - 1.40, p < 0.001, compared to the BITA group and H.R. 1.36 95% CI 1.09- 1.69 compared to the RA group) (Cox model ).
Conclusions: This large cohort study support the use of BITA and RA in patients older than 70. It shows improved long-term (Kaplan Meier) and Cox-adjusted- survival of elderly patients who underwent CABG with arterial grafts.
