Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly
Background: The benefits of utilizing internal thoracic arteries (ITAs) in coronary bypass surgery are well-known. However, the safety of this practice in elderly patients needs to be proven. Methods: We studied all patients who are 75 years of age and older, who received at least one ITA graft whil...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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IMR Press
2023-01-01
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| Series: | Reviews in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/RCM/24/1/10.31083/j.rcm2401004 |
| _version_ | 1797937814928621568 |
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| author | Ryan Chaban Ahmed Ghazy Hendrik Treede |
| author_facet | Ryan Chaban Ahmed Ghazy Hendrik Treede |
| author_sort | Ryan Chaban |
| collection | DOAJ |
| description | Background: The benefits of utilizing internal thoracic arteries (ITAs) in coronary bypass surgery are well-known. However, the safety of this practice in elderly patients needs to be proven. Methods: We studied all patients who are 75 years of age and older, who received at least one ITA graft while undergoing isolated, conventional (median sternotomy) coronary artery bypass graft surgery (CABG) between Jan 1st 2002 and Dec 31st 2020 (19 years). Emergent surgeries were excluded. Propensity score matching was used to reduce the patient selection effect. Study outcomes were 30-days mortality, and two sets of dependent intraoperative parameters and postoperative parameters. Results: A total of 1855 patients undergoing CABG was included, of which 1114 received a single left (s)ITA and 741 received combined left and right (d)ITA grafts. 519 pairs were matched. The decision for sITA or dITA was made individually. Thirty-days mortality was low and similar in both groups (sITA 3.3%; dITA 2.9%, p = 0.859). The incidence of sternal wound healing disorder was higher after dITA (3.3 vs 6.9%; p < 0.011), which had also a longer skin-to-skin operative time (181 vs 205 min; p < 0.0001). Re-thoracotomy rates were similar (4.6 vs 6.2%; p = 0.340). There were no significant differences in other secondary parameters. Conclusions: harvesting both ITAs in elderly patients is safe and feasible. However, it increases the risk of sternal wound healing disorders. Long term benefit still needs to be proven. |
| first_indexed | 2024-04-10T18:50:09Z |
| format | Article |
| id | doaj.art-35b9b6a7d8044615ad3ee4e3e7a429e1 |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-04-10T18:50:09Z |
| publishDate | 2023-01-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-35b9b6a7d8044615ad3ee4e3e7a429e12023-02-01T07:32:12ZengIMR PressReviews in Cardiovascular Medicine1530-65502023-01-01241410.31083/j.rcm2401004S1530-6550(22)00773-6Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in ElderlyRyan Chaban0Ahmed Ghazy1Hendrik Treede2Department of Cardiovascular Surgery, University Hospital of Johannes Gutenberg University, 55131 Mainz, GermanyDepartment of Cardiovascular Surgery, University Hospital of Johannes Gutenberg University, 55131 Mainz, GermanyDepartment of Cardiovascular Surgery, University Hospital of Johannes Gutenberg University, 55131 Mainz, GermanyBackground: The benefits of utilizing internal thoracic arteries (ITAs) in coronary bypass surgery are well-known. However, the safety of this practice in elderly patients needs to be proven. Methods: We studied all patients who are 75 years of age and older, who received at least one ITA graft while undergoing isolated, conventional (median sternotomy) coronary artery bypass graft surgery (CABG) between Jan 1st 2002 and Dec 31st 2020 (19 years). Emergent surgeries were excluded. Propensity score matching was used to reduce the patient selection effect. Study outcomes were 30-days mortality, and two sets of dependent intraoperative parameters and postoperative parameters. Results: A total of 1855 patients undergoing CABG was included, of which 1114 received a single left (s)ITA and 741 received combined left and right (d)ITA grafts. 519 pairs were matched. The decision for sITA or dITA was made individually. Thirty-days mortality was low and similar in both groups (sITA 3.3%; dITA 2.9%, p = 0.859). The incidence of sternal wound healing disorder was higher after dITA (3.3 vs 6.9%; p < 0.011), which had also a longer skin-to-skin operative time (181 vs 205 min; p < 0.0001). Re-thoracotomy rates were similar (4.6 vs 6.2%; p = 0.340). There were no significant differences in other secondary parameters. Conclusions: harvesting both ITAs in elderly patients is safe and feasible. However, it increases the risk of sternal wound healing disorders. Long term benefit still needs to be proven.https://www.imrpress.com/journal/RCM/24/1/10.31083/j.rcm2401004cardiothoracic surgerycoronary artery bypass surgeryelderly patientsinternal thoracic artery |
| spellingShingle | Ryan Chaban Ahmed Ghazy Hendrik Treede Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly Reviews in Cardiovascular Medicine cardiothoracic surgery coronary artery bypass surgery elderly patients internal thoracic artery |
| title | Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly |
| title_full | Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly |
| title_fullStr | Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly |
| title_full_unstemmed | Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly |
| title_short | Perioperative Safety of Bilateral Internal Thoracic Artery Coronary Bypass in Elderly |
| title_sort | perioperative safety of bilateral internal thoracic artery coronary bypass in elderly |
| topic | cardiothoracic surgery coronary artery bypass surgery elderly patients internal thoracic artery |
| url | https://www.imrpress.com/journal/RCM/24/1/10.31083/j.rcm2401004 |
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