Abstract:
We retrospectively evaluated early clinical results of coronary revascularization using
none but arterial grafts in patients aged 65 years and older. The cases of 449 consecutive
patients who had undergone isolated myocardial revascularization were divided into 2
groups: the arterial conduit group (n=107) received a left internal mammary artery (LIMA)
graft and 1 or both radial arteries (RAs), while the mixed-conduit group (n=342) received a
LIMA graft and 1 or more saphenous vein grafts (SVGs), with or without an RA.
There was no significant difference between the groups’ rates of mortality. The arterial
conduit group had a significantly shorter overall postoperative hospital stay than did
the mixed-conduit group (mean, 6.6 ± 0.9 vs 7.2 ± 5 days; P=0.04). Linear regression
analysis revealed that the presence of hypertension (β=0.13; 95% confidence interval [CI],
0.054–0.759; P=0.02) and high EuroSCORE (β=0.24; 95% CI, 0.053–0.283; P=0.004)
were the major predicting factors for long hospital stay. Graft-harvest-site infection was
statistically more frequent in the mixed-conduit group than in the arterial conduit group
(6.4% vs 0, respectively; P=0.007). Angiography was performed postoperatively (mean,
24.9 ± 16.3 mo; range, 11–65 mo) in 21 patients. In these patients, all LIMA grafts were
patent, as were 86.9% of the SVGs and 90.9% of the RA grafts.
Myocardial revascularization using all arterial grafts (at least 50% RAs) in patients aged
65 years and older is safe and reliable, produces short-term results equal to those of saphenous
vein grafting, and can reduce graft-harvest-site infections. (Tex Heart Inst J 2010;
37(3):301-6)
