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Ann Thorac Surg 1996;62:16-22
© 1996 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Internal Thoracic Artery for Coronary Artery Grafting in Octogenarians

Rohinton J. Morris, MD, Michael D. Strong, MD, Karl E. Grunewald, MD, M. L. Ray Kuretu, MD, Louis E. Samuels, MD, J. Yasha Kresh, PhD, Stanley K. Brockman, MD

Department of Cardiothoracic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania

Background. Use of the left internal thoracic artery as a bypass graft has been shown to result in better long-term patency and improved survival. In elderly patients, the internal thoracic artery has been used less often for coronary artery bypass grafts because of the belief that greater morbidity and mortality are associated with this procedure. This study was undertaken to test this premise in the octogenarian population.

Methods. Over an 8-year period, 474 consecutive patients 80 years of age and greater had coronary artery bypass grafting. The left internal thoracic artery was used in 188 patients (39.7%) (group 1) and saphenous vein grafts only (group 2), in 286 (60.3%). The mean age was 82.6 years (range, 80 to 95 years). There were 312 men (65.8%) and 162 women (34.2%).

Results. Use of the internal thoracic artery as a graft has risen steadily each year, as has the number of patients who are octogenarians. The hospital mortality rate was 7.8%. Patients in group 1 had a mortality rate of 9.0% and patients in group 2, a mortality rate of 7.0%. The mortality rate among survivors at 1 year was 6.7%. Long-term survival was significantly greater in group 1.

Conclusions. On the basis of this study, we conclude that the internal thoracic artery is the bypass graft of choice, especially in regard to long-term mortality, and should not be denied to this high-risk group.


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Discussion
Ann. Thorac. Surg. 1996 62: 22. [Extract] [Full Text]



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