Effect of age on outcome of bilateral skeletonized internal thoracic artery grafting

Background. Elderly patients are considered to be at higher risk for corona ry artery bypass grafting. Surgical techniques of arterial myocardial revas cularization without vein grafts were primarily reserved for the young. Thi s report evaluates the impact of age on the outcome of 634 consecutive pati ents who underwent double skeletonized internal thoracic artery grafting be tween April 1996 and December 1997. Methods. Patients were stratified into five age groups: One hundred ninety- six were less than 60 years of age, 98 between 60 and 65 years, 132 between 65 and 70 years, 116 between 70 and 75 years, and 92 were older than 75 ye ars. The groups did not differ with regard to preoperative risk factors. Results. Hospital mortality was 2.5% (n = 16). Mortality of urgent and elec tive operations was 1.6%, and that of emergency operations was 9.7% (p < 0. 001). There were 7 (1.1%) myocardial infarctions, 9 strokes (1.4%), and 10 deep sternal wound infections (1.6%). Using the Mantel-Haenszel test, there was no relation between age and hospital mortality, myocardial infarctions , strokes, or sternal infections. A correlation was found between advanced age and early unfavorable events (6.7%, 7.2%, 12.9%, 15.5%, and 15.2% in co rresponding age groups, p < 0.003), and late mortality (0.6%, 1%, 1.5%, 4.3 %, and 9.8%, respectively, p < 0.01). However, early return of angina was l ower (2.6%, 1%, 0.8%, 0.9%, and 0%, p < 0.06). Conclusions. This retrospective, nonrandomized study suggests that older ag e is not a risk factor for operative mortality in patients undergoing coron ary artery bypass grafting with double skeletonized internal thoracic arter ies. Apart from avoiding morbidity associated with leg incisions, older pat ients showed an interesting trend toward lower rates of angina return. Olde r patients, however, sustained increased perioperative morbidity and late m ortality rates. (C) 2001 by The Society of Thoracic Surgeons.