Mid-Term Outcome of Total Arterial Myocardial Revascularization in Patients Older than 70 Years

Objectives: The aim of our study was to assess the benefit of total arterial revascularization compared with conventional coronary artery bypass graft (CABG) surgery for patients older than 70 years.

Methods: In a retrospective study, between 01/2005 and 12/2011, a total of 178 patients older than 70 years (age: 75.2 ± 4.0 years; 68.5% male) underwent isolated CABG and total arterial revascularization in our institution. This cohort was matched for age-, gender- and EuroSCORE to 178 patients who underwent conventional CABG (left internal thoracic artery plus saphenous veins). Major adverse cardiac and cerebrovascular events (MACCE) were evaluated.

Results: Demographic data were similar in both groups. In the study group, bilateral internal thoracic arteries were used in 104 patients (58.4%) and the radial artery grafts were used in 153 patients (86%). Intraoperatively, the number of distal anastomoses (3.6 ± 0.6 vs. 2.9 ± 0.8; p < 0.001) was significantly higher in the control group. Postoperatively, no significant differences in complications and major morbidity were observed between the groups. 30 days survival (97.2 vs. 96.1%) was similar between the groups. At a median follow-up of 6.1 ± 2.7 years (range: 3.2–10.6 years), one-year (97.2 vs. 95.5%), 3 years (96.1 vs. 94.4%) and 5 years (95.5 vs. 92.2%) survival rates were satisfactory for both groups. However, the study group was associated with lower rates of repeat revascularization (3.4 vs. 9.6%; p = 0.029).

Conclusion: Our analysis suggests that total arterial revascularization improves clinical outcome of elderly undergoing CABG. However, randomized, prospective studies with prolonged follow-up are needed to investigate the role of total arterial revascularization in this patient Population.

No conflict of interest has been declared by the author(s).