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Coronary Artery Bypass Grafting in Elderly Patients: Insights from a Comparative Analysis of Total Arterial and Conventional Revascularization

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Abstract

The benefits of total arterial (TAR) versus conventional (CR) revascularization are controversial in the higher-risk cohort of elderly patients. Taking for granted its benefit on long-term survival, we evaluated the effect of TAR on safety (death, myocardial infarction, and stroke) of patients undergoing CABG. Between 2000 and 2009, 487 patients >75 years underwent isolated CABG at our institution (150 TAR and 337 CR). Patients with arterial free-grafts were excluded. After propensity matching, the outcomes of 131 TAR and 127 CR patients were compared. TAR patients had lower incidence of post-operative myocardial infarction (p = 0.025) and stroke (p = 0.005). They also experienced shorter intensive care unit (p = 0.046) and ward stay (p = 0.028), lower output of TnI (p = 0.035), and less wound complications (leg included) (p = 0.0001), while mortality was comparable (p = 0.57). In our cohort of elderly patients with multivessel disease, TAR was associated with lower rates of myocardial infarction, stroke, and shorter hospital stay.

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Abbreviations

CABG:

Coronary artery bypass grafting

CCS:

Canadian Coronary Score

CR:

Conventional revascularization

CT:

Computed tomography

IABP:

Intra-aortic balloon counterpulsation

ICU:

Intensive care unit

ITA:

Internal thoracic artery

LM:

Left main

MACCE:

Major adverse cardiovascular and cerebrovascular events

NYHA:

New York Heart Association

PCI:

Percutaneous coronary intervention

QoL:

Quality of life

TAR:

Total arterial revascularization

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Acknowledgments

The authors wish to acknowledge Dr. Giulio Rizzoli, MD, for his help with the statistical analysis.

Author information

Authors and Affiliations

  1. Cardiac Surgery Unit; Department of Cardiac, Thoracic and Vascular Surgery, University of Padova Medical School, Padova, Italy

    Giacomo Bortolussi, Jonida Bejko, Michele Gallo, Marina Comisso, Massimiliano Carrozzini, Cosimo Guglielmi, Luca Testolin, Giuseppe Toscano, Maurizio Rubino, Roberto Bianco, Vincenzo Tarzia, Gino Gerosa & Tomaso Bottio

Authors
  1. Giacomo Bortolussi
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  2. Jonida Bejko
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  3. Michele Gallo
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  4. Marina Comisso
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  5. Massimiliano Carrozzini
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  6. Cosimo Guglielmi
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  7. Luca Testolin
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  9. Maurizio Rubino
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  10. Roberto Bianco
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  11. Vincenzo Tarzia
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  12. Gino Gerosa
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  13. Tomaso Bottio
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Corresponding author

Correspondence to Tomaso Bottio.

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Conflict of Interest

The authors received no funding for the present study and have no conflict of interest to declare.

Human Subjects/Informed Consent Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

Additional information

Editor-in-Chief Jennifer L. Hall oversaw the review of this article

Clinical Relevance

We retrospectively analyzed a cohort of elderly patients with multivessel disease who underwent coronary artery bypass grafting with cardiopulmonary bypass and cross clamping. After propensity matching, single-clamp, total arterial revascularization was associated with lower rates of myocardial infarction, stroke, and shorter hospital stay with respect to the conventional technique.

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Bortolussi, G., Bejko, J., Gallo, M. et al. Coronary Artery Bypass Grafting in Elderly Patients: Insights from a Comparative Analysis of Total Arterial and Conventional Revascularization. J. of Cardiovasc. Trans. Res. 9, 223–229 (2016). https://doi.org/10.1007/s12265-016-9688-y

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  • DOI: https://doi.org/10.1007/s12265-016-9688-y

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