Should Bilateral Internal Thoracic Artery (BITA) Grafting Be Used In Elderly Patients Undergoing Coronary Artery Bypass Grafting?
Background—Although Bilateral Internal Thoracic Artery (BITA) grafting is associated with improved survival, the use of this technique in 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 and Results—Between 1996 and 2001, 1714 consecutive patients underwent skeletonized BITA grafting, of whom 748 were 65 years of age or younger, 688 were between 66 and 75 and 278 were 76 or older. Operative mortality of the three age groups (1.2%, 4.1% and 5.8%) was lower than the logistic Euroscore predicted mortality (3.9%, 6.5%, 9.3%, respectively, p<0.001). There was no significant difference between groups in occurrence of sternal infection (1.3%, 2.6% and 1.4% respectively, p=0.171). 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). They were 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). Age 65 or younger (HR 0.232, 95% Ci 0.188-0.288) and 66-75 (HR 0.499, 95% Ci 0.414-0.602) were independent predictors of improved survival (Cox Model)
Conclusions—BITA grafting should be considered in patients older than 65, due to the significant survival benefit obtained with this surgical technique without additional risk of sternal wound infection related to age.
- Received January 17, 2013.
- Revision received April 2, 2013.
- Accepted April 26, 2013.