Influence of internal mammary artery grafting and completeness of revascularization on long-term outcome in octogenarians

Background. It has been well established that complete revascularization wi th internal mammary artery (IMA) grafting is important in young patients un dergoing coronary artery bypass grafting (CABG). Applying these principles to octogenarians remains controversial. Methods. From 1986 to 1999, 358 consecutive patients aged 80 to 94 years un derwent CABG. Revascularization was complete in 291 (81%) and incomplete in 67 (19%). The IMA was used in 231 (65%) cases. Results. Operative mortality was 7% +/- 1%, but was not statistically diffe rent with or without IMA grafting (IMA 5% +/- 2% versus no IMA 10% +/- 3%, p = 0.11) or complete revascularization (p > 0.41). Midterm survival improv ed with IMA grafting (70% +/- 3% versus 56% +/- 5% at 4 years, p < 0.03; 36 % +/- 4% versus 29% +/- 5% at 8 years, p < 0.08), but was not significant b eyond 8 years. Among 138 survivors, those with IMA grafts were more likely to be angina free (82% versus 53%, p < 0.001) and in New York Heart Associa tion class I (60% versus 36%, p < 0.03). Survival, recurrent angina, and fu nctional class were independent of completeness of revascularization (p > 0 .21). Conclusions. IMA grafting improved survival, angina, and functional class o f octogenarians, but complete revascularization did not have a similar impa ct. (C) 2001 by The Society of Thoracic Surgeons.