Complete arterial revascularization in octogenarians using bilateral IMA grafts: Clinical experience in 316 consecutive patients

Objectives: The recent SYNTAX-trial highlighted neurologic complications in CABG patients. Octogenarians are most vulnerable to perioperative strokes. Complete arterial revascularization (CAR) utilizing an aorta non-touch-technique (ANTT) as well as OPCAB offers reduced postoperative morbidity and thus improved postoperative quality of life (QOL). This retrospective study was undertaken to assess clinical outcome in octogenarians after isolated surgical revascularization with different operative strategies.

Methods: Between 01.01.2000 and 01.07.2010, 316 consecutive octogenarians (60.5% men) (mean age 82.2±2.2; range 80 to 93 years) underwent routine CAR with ANTT using bilateral skeletonized IMA grafts (3.1±0.8 anastomoses) either with CPB (groupA, n=204) or without CPB (groupB, n=112). Follow-up (96.8% complete) was obtained using a patient SF-36 mail-questionnaire.

Results: Preoperative characteristics were comparable between groups. Mean operative time, intubation time and ICU stay was shorter in group B (p<0.05). Overall 30d-mortality, incidence of postoperative permanent or transient neurological deficit and sternal wound infection was 2.5%, 0.9% and 1.6%, respectively (NS). Unadjusted 5-year survival was 82.8% and 88.5% (NS). Postoperative QOL was determined by gender, preoperative renal impairment, diabetes and COPD. After adjustment in a multivariate model, postoperative QOL was similar between groups A and B and comparable to an age and gender matched normal population.

Conclusion: CAV with ANTT in this set of patients was achieved with low operative mortality and morbidity with excellent long-term results. OPCAB was associated with faster short term recovery but did not further reduce neurologic complications. Postoperative QOL using the SF-36 protocol was determined by comorbidities rather than operative strategy.