Extended arterial revascularization (arterial T-graft procedures) in patients >70 years – a successful concept?

Aims: Bypassoperations (CABG) using bilateral thoracic arteries show excellent results in younger patients. Our purpose was to find out if similar results also could be achieved in patients >70. Methods: From Jan. 2003 to Sept. 2006 we performed 1431 CABG operations. 661 patients (46.2%) were >70 years. Patients having Euro-Scores from 3 to 9 points were retrospectively included into group 1: CABG with 1 arterial±venous graft/s (n=515) or group 2: CABG using both thoracic arteries±venous graft/s (n=146) and were compared concerning risk factors, outcome and mortality. Results: Mean age was 74.8 (group 1) and 73.7 (group 2), mean scorepoints were 5.5 (1) vs. 5.4 (2). There were more emergency procedures (3.4% vs. 0.8%) and poor ventricular functions (12.1% vs. 8.4%) in group 1. Group 2 had more diabetes (23.7% vs. 13.6%) and extracardial arteriopathie (23.7% vs. 8.4%). Group 2 also had more neurological symptoms (10.7% vs. 6.3%) and tracheotomias (5.3% vs. 24%) whereas Group 1 showed a higher percentage of kidney failure (6.8% vs. 3.1%) postoperatively. 85.4% (1) and 84.1% (2) of the CABG-patients reported to feel good 4 months after operation but Group 2 had higher rates of in hospital (4.4% vs. 2.6%), 30-days (5.3% vs. 2.9%) and 90 days (7.1% vs. 2.9%) mortality. Conclusion: Our results indicate that the excellent results in younger patients (CABG using both thoracic arteries) cannot similarly be achieved in the elderly. Extended arterial grafting in the elderly only should be performed if no other bypass material is available.