Abstract
OBJECTIVE: Although the use of the left thoracic artery (LITA) is well accepted as the optimal conduit in coronary artery bypass graft surgery to improve survival, the survival benefit for the most elderly population is less well defined. Herein, we explore the lifetime benefit for use of the LITA versus saphenous vein grafting (SVG) only in a matched population of patients aged 80 years and older. METHODS: Retrospective review was conducted of consecutive patients aged 80 years and older who underwent isolated coronary artery bypass graft procedures using either SVG only or ITA + SVG grafting between June 1982 and December 2011. Propensity score matching, logistic regression, Kaplan-Meier survival analysis, and Cox regression were used to examine perioperative and long-term survival outcomes. RESULTS: There were 923 SVG patients and 1217 ITA + SVG patients. After propensity score matching there were 923 in each group. Follow-up ranged from 5 weeks to 25 years and was 99% complete. For matched patients, the operative mortality was 10.9% (101 out of 923) for SVG only and 7.8% (72 out of 923) (P = .021) for ITA + SVG. When examining long-term outcomes for hospital survivors, ITA + SVG was associated with improved survival (hazard ratio of mortality, 0.88; 95% CI, 0.80-0.97; P = .009). When stratifying the patients by age, it appeared that the survival benefit for ITA + SVG persisted well into the eighth decade of life but may be attenuated as patients approach age 90 years. CONCLUSIONS: Despite their advanced age and limited life expectancy, our data suggest that after adjusting for factors associated with selection bias, octogenarians enjoy long-term survival benefits from the use of ITA grafting.