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Intraoperative behavior of arterial grafts in the elderly and the young: a flowmetric systematic analysis

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Abstract

Extensive arterial grafting (Art-CABG) in the elderly is still questioned due to the reduced life expectancy and the supposed higher periprocedural risk. Reports further demonstrated accelerated atherosclerosis of arterial grafts in the elderly, with hampered short-term and long-term results. We reviewed our experience of patients undergoing Art-CABG between January 2003 and January 2007, divided into two groups: the elderly (238 patients ≥70 years; Group A) and the young (195 patients ≤60 years; Group B). Transit time flowmetric (TTF) maximum and mean flow, pulsatility index (PI), and graft flow reserve (GFR) were compared. Hospital outcome was analyzed. Hospital mortality, need for intra-aortic balloon pump, troponin I, and echocardiographic segmental kinetics were comparable between the two groups (P = not significant [NS]). Stratifying patients for target vessels and type of arterial CABG, no differences in TTF results were recorded between the two groups either on-pump (P = NS) and off-pump (P = NS), both for the two internal mammary arteries (P = NS irrespective of the target vessel) and the radial artery conduits (P = NS irrespective of the target vessel). Although graft flow reserve was significantly recruited in all patients (P < 0.05 in young and elderly, either on-pump and off-pump, irrespective of the arterial conduit and the grafted vessel), GFR of all arterial grafts was comparable between elderly and young patients, either on-pump (P = NS) or off-pump (P = NS). Art-CABG showed similar TTF results in elderly and young patients, regardless of the arterial conduit, target vessel, or surgical technique employed. These functional results supported the reported survival benefit of arterial revascularization in the elderly.

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References

  1. Lytle BW, Blackstone EH, Loop FD, Houghtaling PL, Arnold JH, Akhrass R, McCarthy PM, Cosgrove DM (1999) Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855–872

    Article  PubMed  CAS  Google Scholar 

  2. Bonacchi M, Prifti E, Maiani M, Frati G, Giunti G, Di Eusanio M, Di Eusanio G, Leacche M (2006) Perioperative and clinical-angiographic late outcome of total arterial myocardial revascularization according to different composite original graft techniques. Heart Vessels 21:69–77

    Article  PubMed  Google Scholar 

  3. Ferguson TB, Dziuban SW, Edwards FH, Eiken MC, Shroyer AL, Pairolero PC, Aderson RP, Grover FL (2000) The STS National Database: current changes and challenges for the new millennium. Ann Thorac Surg 69:680–691

    Article  PubMed  Google Scholar 

  4. Nashef SAM, Roques F, Michel P, Cortina J, Faichney A, Gams E, Harjula A, Jones MT (2000) Coronary surgery in Europe: comparison of the national subsets of the European System for Cardiac Operative Risk Evaluation database. Eur J Cardiothorac Surg 17: 396–399

    Article  PubMed  CAS  Google Scholar 

  5. Morris RJ, Strong MD, Grunewald KE, Kuretu MLR, Samuels LE, Kresh JY, Brockman SK (1996) Internal thoracic artery for coronary artery grafting in octogenarians. Ann Thorac Surg 62:16–22

    Article  PubMed  CAS  Google Scholar 

  6. Simek M, Nemec P (2007) Postoperative and mid-term wound disturbance outcomes of minimally invasive saphenous vein harvest using the VEGA system. Heart Vessels 22:94–98

    Article  PubMed  Google Scholar 

  7. Chowdhury UK, Airan B, Mishra PK, Kothari SS, Subramaniam GK, Ray R, Singh R, Venugopal P (2004) Histopathology and morphometry of radial artery conduits: basic study and clinical application. Ann Thorac Surg 78:1614–1621

    Article  PubMed  Google Scholar 

  8. Takami Y, Ina H (2001) Relation of intraoperative flow measurement with postoperative quantitative angiographic assessment of coronary artery bypass grafting; Ann Thorac Surg 72:1270–1274

    Article  PubMed  CAS  Google Scholar 

  9. Onorati F, Renzulli A, De Feo M, Santarpino G, Gregorio R, Biondi A, Cerasuolo F, Cotrufo M (2003) Does antegrade blood cardioplegia alone provide adequate myocardial protection in patients with left main stem disease? J Thorac Cardiovasc Surg 126:1345–1351

    Article  PubMed  Google Scholar 

  10. D’Ancona G, Karamanoukian HL, Ricci M, Schmid S, Bergsland J, Salerno TA (2000) Graft revision after transit time flow measurement in off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 17:287–293

    Article  PubMed  CAS  Google Scholar 

  11. Tedoriya T, Kawasuji M, Sakakibara N, Takemura H, Watanabe Y, Hetzer R (1998) Coronary bypass flow during use of intraaortic balloon pumping and left ventricular assist device. Ann Thorac Surg 66:477–481

    Article  PubMed  CAS  Google Scholar 

  12. Onorati F, Olivito S, Mastroroberto P, di Virgilio A, Esposito A, Perrotti A, Renzulli A (2005) Perioperative patency of coronary artery bypass grafting is not influenced by off-pump technique. Ann Thorac Surg 80:2132–2140

    Article  PubMed  Google Scholar 

  13. Onorati F, Renzulli A, De Feo M, Galdieri N, Santè P, Mastroroberto P, Bilotta M, Cotrufo M (2004) Perioperative enoximone infusion improves cardiac release after CABG. J Cardiothorac Vasc Anesth 18:409–414

    Article  PubMed  CAS  Google Scholar 

  14. Peterson ED, Jollis JG, Bebchuk JD, DeLong ER, Muhlbaier LH, Mark DB, Pryor DB (1994) Changing mortality following myocardial revascularization in the elderly: the National Medicare Experience. Ann Intern Med 121:919–927

    PubMed  CAS  Google Scholar 

  15. The TIME Investigators (2001) Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet 358:951–957

    Article  Google Scholar 

  16. Graham MM, Ghali WA, Faris LP, Galbraith PD, Norris CM, Knudtson ML (2002) APPROACH Investigators. Survival after coronary revascularization in the elderly. Circulation 105:2378–2384

    Article  PubMed  Google Scholar 

  17. Loop FD, Lytle BD, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LA, Gill CC, Taylor PC, Sheldon WC (1986) Influence of the internal mammary artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1–6

    PubMed  CAS  Google Scholar 

  18. Edwards FH, Clark RE, Schwarz M (1994) Impact of internal mammary artery conduits on operative mortality in coronary revascularization. Ann Thorac Surg 57:27–32

    Article  PubMed  CAS  Google Scholar 

  19. Leavitt BJ, O’Connor GT, Olmstead EM, Morton JR, Maloney CT, Dacey LJ, Hernandez F, Lahey SJ (2001) Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation 103:507–512

    PubMed  CAS  Google Scholar 

  20. Ferguson TB Jr, Coombs LP, Peterson ED (2002) Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement? J Thorac Cardiovasc Surg 123:869–880

    Article  PubMed  Google Scholar 

  21. Wildhirt SM, Voss B, von Canal F, Benz M, Grammer JB, Bauernschmitt R, Tassani P, Lange R (2006) Graft function, histopathology and morphometry of radial arteries used as conduits for myocardial revascularization in patients beyond age 70. Eur J Cardiothorac Surg 30:333–340

    Article  PubMed  Google Scholar 

  22. Gaudino M, Tondi P, Serricchio M, Spatuzza P, Santoliquido A, Flora R, Girala F, Nasso G, Pola P, Possati G (2003) Atherosclerotic involvement of the radial artery in patients with coronary artery disease and its relation with midterm radial artery graft patency and endothelial function. J Thorac Cardiovasc Surg 126:1968–1971

    Article  PubMed  Google Scholar 

  23. Calafiore AM, Contini M, Vitella G, Di Mauro M, Mazzei V, Teodori G, Di Giammarco G (2000) Bilateral internal thoracic artery grafting: long term clinical and angiographic results of in situ versus Y grafts. J Thorac Cardiovasc Surg 120:990–998

    Article  PubMed  CAS  Google Scholar 

  24. Muneretto C, Negri A, Bisleri G, Manfredi J, Terrini A, Metra M, Nodari S, Dei Cas L (2003) Is total arterial myocardial revascularization with composite grafts a safe and useful procedure in the elderly? Eur J Cardiothorac Surg 23:657–664

    Article  PubMed  Google Scholar 

  25. Kurlansky PA, Williams DB, Traad EA, Carrillo RG, Schor JS, Zucker M, Singer S, Ebra G (2003) Arterial grafting results in reduced operative mortality and enhanced long-term quality of life in octogenarians. Ann Thorac Surg 76:418–427

    Article  PubMed  Google Scholar 

  26. Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, Collins P, Wang D, Sigwart U, Pepper J (2004) A randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery. N Engl J Med 350:21–28

    Article  PubMed  CAS  Google Scholar 

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  1. Francesco Onorati

    Present address: , Viale dei Pini 28, 80131, Napoli, Italy

Authors and Affiliations

  1. Cardiac Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy

    Francesco Onorati, Giuseppe Santarpino, Maria Antonietta Lerose, Barbara Impiombato, Pasquale Mastroroberto & Attilio Renzulli

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  1. Francesco Onorati
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  2. Giuseppe Santarpino
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  3. Maria Antonietta Lerose
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  5. Pasquale Mastroroberto
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  6. Attilio Renzulli
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Onorati, F., Santarpino, G., Lerose, M.A. et al. Intraoperative behavior of arterial grafts in the elderly and the young: a flowmetric systematic analysis. Heart Vessels 23, 316–324 (2008). https://doi.org/10.1007/s00380-008-1055-8

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  • DOI: https://doi.org/10.1007/s00380-008-1055-8

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