Article
Outcome of total arterial versus conventional myocardial revascularization in patients aged 70 years and older
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Published: | March 21, 2014 |
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Introduction: Controversy still exists about averting expenditure of health care resources on the growing elderly population. Several studies demonstrated that patients receiving arterial grafts have superior late survival after coronary artery bypass graft surgery (CABG). The aim of this study was to evaluate the results of total arterial revascularization compared with conventional coronary surgery in the elderly.
Material and methods: A retrospective, observational study on an age-, gender- and EuroSCORE-matched cohort of patients aged more than 70 years, who underwent isolated CABG between 01/2005 and 12/2011, was performed. 356 patients were enrolled and assigned to Group 1 (G1) = 178 patients, for total arterial revascularization or Group 2 (G2) = 178 patients, for conventional CABG (left internal thoracic artery plus saphenous veins). Major adverse cardiac and cerebrovascular events (MACCE) were evaluated.
Results: No significant difference was noted between the two groups with regard to preoperative risk factors (age, EuroSCORE, left-ventricular ejection fraction, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and obesity). No differences between both groups were observed in terms of mean aortic cross-clamping time (G1 = 66 ± 19 min vs. G2 = 65 ± 21 min), re-exploration for bleeding (G1 = 3.9% vs. G2 = 2.8%), transfusion requirements (G1 = 2 [0 to 3] units vs. G2 = 2 [0 to 4] units), mechanical ventilation time (G1 = 16 [11 to 22] h vs. G2 16 [11 to 22] h), incidences of postoperative acute renal injury (G1 = 6% vs. G2 = 6%), and sternal wound infection (G1 = 5% vs. G2 = 3.4%), intensive care unit (ICU) stay (G1 = 2 [2 to 3] days vs. G2 = 2 [2 to 3] days) and hospital stay (G1 = 8 [7 to 12] days vs. G2 = 8 [7 to 12] days) (p>0.05). Survival free of cardiac death or myocardial infarction (G1 = 97.2% vs. G2 = 96.6%) and MACCE-free survival (G1 = 94.4% vs. G2 = 97.2%) at follow-up of 30 days were similar between the groups. At a mean follow-up of 26 ± 11 months, no differences between both groups were observed in terms of survival free of cardiac death or myocardial infarction (G1: 91.6% vs. G2 = 90.4%). However, G1 was associated with lower rates of repeat revascularization (G1 = 2.8% vs. G2 = 8.4%; p=0.036).
Conclusion: This study suggests that total arterial revascularization proved to be a safe and effective procedure with superior late outcome also in the elderly. Lower rate of late cardiac events encourage the use of total arterial revascularization for CABG.