Abstract 13917: Effect of Age on Long-Term Outcome of Patients Undergoing Bilateral Internal Thoracic Artery Grafting
Objective(s): Although bilateral ITA grafting is associated with improved survival, the use of this technique in the elderly is controversial due to their increased surgical risk and shorter life expectancy. The purpose of this study is to evaluate the effect of age on outcome of patients undergoing BITA grafting.
Methods: Between 1996 and 2001, 1714 consecutive patients underwent BITA grafting, of whom 748 were 65 years of age or younger, 688 were between 66 and 75 and 278 were 76 or older.
Results: Operative mortality of the three age groups (1.2%, 4.1% and 5.8%) was lower than the Euroscore predicted mortality (3.9%, 6.5%, 9.3%, respectively, p<001). COPD (p=0.02), preoperative old (p=0.04) or acute (p=0.001) MI, emergency operation (p<0.001), increased age (p=0.01), PVD (p=0.05), and EF<25% (p=0.05), were independent predictors of operative mortality. Sternal infection occurred in 32 patients (1.9%). Repeat operation (p<0.001), COPD (p<0.001), PVD (p=0.04), and Diabetes (p=0.001), were identified as independent predictors of sternal wound infection. Mean follow-up was 11.5 years. Kaplan-Meier 10-year survival for patients <65, 66-75 and >75 years of age was 85%, 65% and 40%, respectively (p<0.001). This was better than the corresponding predicted Charlson Comorbidity Index survivals (68%, 37%, and 20%, respectively, p<0.001 for all age groups), approaching survival of gender and age matched general population (90%, 70%, and 41%, respectively). Predictors of decreased survival (Cox model) were older age (p<0.001), congestive heart failure (p<0.001), diabetes (p<0.001), COPD (p<0.001), chronic renal failure (p=0.03), EF<25% (p=0.002), repeat operation (p=0.01), preoperative MI (p=0.03), PVD (p<0.001), and preoperative IABP support (p=0.005).
Conclusions: BITA grafting should be considered in patients older than 65, despite increased early and late mortality, due to the significant survival benefit obtained with this surgical technique without additional risk of sternal wound infection related to age. It is recommended especially for patients without other risk factors.
- © 2012 by American Heart Association, Inc.