Aims: Bilateral internal thoracic artery (BITA) grafting is associated with a long-term
survival advantage. However, BITA grafting has traditionally been performed in young
patients presenting with coronary artery disease, and some studies have defined 60-years
as cut-off point for its beneficial effect. Our aim was to assess the safety of BITA
in patients >65 years in comparison to younger patients on terms of quality of
life (QOL) and mid-term outcome.
Methods: A retrospective analysis was performed comparing 184 consecutive patients <65
years [mean age:56±2 y; 89.7% male] receiving BITA and supplemental vein grafts with
142 consecutive patients older than 65 years [mean age:72±3 y; 77.4% male] operated
within the same period. Preoperative risk factors and operative data, such as technique,
and number of grafts were analyzed. Postoperative complications, and need for reoperation/intervention
were assessed. A modified SF-36 quality of life (QOL) questionnaire was completed
at follow-up [85% patients; mean 36 months].
Results: Patients>65 had more diabetes and kidney insufficiency, while patients<65 had
more hypercholesterolemia and smoking. No differences regarding ejection fraction,
intraoperative data and postoperative complications were recorded. Although the in-hospital
survival was comparable, patients>65 showed a longer hospital stay [13.8d vs. 11.9d;
p=0.01]. At follow-up, freedom from angina, and need for reoperation/intervention
was similar for both groups; however, the patients>65 showed a significant lower
QOL, and a lower non-adjusted survival [91.6% vs. 98.6%; p=0.006]
Conclusions: BITA revascularisation in patients >65 seems a safe surgical option regarding
30-day survival and operative outcome. However, patients >65 present a lower mid-term
survival and QOL.
