Total Arterial Myocardial Revascularization Among Elder Patients - 10 Years Survival Analysis
Jacek Piatek1, Anna Kedziora2, Janusz Konstanty-Kalandyk2, Krzysztof Bryniarski2, Boguslaw Kapelak2.
1John Paul II Hospital, Krakow, Poland, 2John Paul II Hospital, Kraków, Poland.
OBJECTIVE: LIMA to LAD graft has been proven to prolong survival and diminish early mortality following CABG among all patients groups, regardless of age and comorbidities. However, indications for other arterial grafts usage remains disputable. In spite of recent 10 years ART Trial results publication, there is still limited evidence in terms of long-term benefit of total arterial revascularization, especially in elder population, as the mean age of the trial patients was below 70 years old. Therefore, the presented report is the first to evaluate safety and efficacy of total arterial revascularization (TAMR) in elder patients based on the real-life register data. METHODS: A total of 200 patients aged 70 years old or older at the time of surgery were consecutively enrolled into the case-control registry (age: 74.2±3 years; EuroSCORE II: 2.3±2; LVEF: 52.7±10%). 100 patients underwent TAMR, and 100 patients in the control group underwent conventional CABG with LIMA-LAD and venous grafts for other coronary lesions. The groups did not differ within the baseline parameters, except from varicose veins, which were more common in the study group. The median follow-up period is 124 (99-144) months. RESULTS: Among other assesed complications, postoperative myocardial infarction occurred with the approximate frequency between the groups (TAMR: 6% vs Control: 2%; p>0.05). Similar was the 30-day mortality, and deep sternal wound infection (1% vs 2%; p>0.05 and 4% vs 2%; p>0,05). The long-term survival did not differ between the groups (log rank p=0.785; Figure 1). In the multivariate Cox-regression model preoperative LVEF, and tobacco use were independent survival predictors. CONCLUSIONS: Total arterial revascularization is a safe surgical revascularization strategy for elder patients, however, no long-term survival benefit can be observed in this population.
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