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Bilateral internal thoracic artery grafting in octogenarians: where are the benefits?

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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.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy

    Giuseppe Gatti, Bernardo Benussi, Lorella Dreas, Gabriella Forti, Marco Gabrielli, Elisabetta Rauber & Aniello Pappalardo

  2. Division of Cardiology, Ospedali Riuniti, Trieste, Italy

    Luca Dell’Angela & Gianfranco Sinagra

  3. Division of Infective Diseases, Ospedali Riuniti, Trieste, Italy

    Roberto Luzzati

  4. Division of Cardiac Surgery, Ospedale di Cattinara, via P. Valdoni, 7, 34148, Trieste, Italy

    Giuseppe Gatti

Authors
  1. Giuseppe Gatti
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  2. Luca Dell’Angela
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  3. Bernardo Benussi
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  4. Lorella Dreas
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  5. Gabriella Forti
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  7. Elisabetta Rauber
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  9. Gianfranco Sinagra
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  10. Aniello Pappalardo
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Correspondence to Giuseppe Gatti.

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Gatti, G., Dell’Angela, L., Benussi, B. et al. Bilateral internal thoracic artery grafting in octogenarians: where are the benefits?. Heart Vessels 31, 702–712 (2016). https://doi.org/10.1007/s00380-015-0675-z

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  • DOI: https://doi.org/10.1007/s00380-015-0675-z

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