Is the use of BITA vs SITA grafting safe and beneficial in octogenarians

BACKGROUND Bilateral internal thoracic artery grafts (BITA) is questionable in octogenarians because of shorter life expectancy and increased risk of perioperative complications. The aim of this study was to examine the safety and effectiveness of performing BITA and single internal thoracic artery grafts (SITA) in patients older than 80 years. METHODS This study compared outcome 201 consecutive octogenarians who underwent isolated BITA grafting with those of 280 consecutive octogenarians who underwent SITA and saphenous vein grafting during 1996-2011. Insulin dependent diabetes, ejection fraction < 30 and emergency operations were more common among those who underwent SITA, and the prevalence of left main disease was lower. Propensity score matching was used to control for these differences, thus generating well-matched groups of 190 patients each. RESULTS There were no significant differences in early mortality between the unmatched groups: 3.2% in the BITA and 8.6% in the SITA group (p=0.12). Rates of sternal wound infection were also similar, 1.5% versus 1.7%. Differences were not observed in the occurrences of perioperative stroke (3.5% versus 2.5%, p= 0.999) and myocardial infarction (1.5% versus 3.6%, P= 0.166). The results were similar for the matched groups. Long-term survival between the unmatched groups, and survival between the matched groups were not significantly different. CONCLUSIONS This study shows equal long-term survival for BITA and SITA grafting in octogenarians. BITA is an acceptable alternative to SITA grafting in low-risk octogenarians and in the presence of calcified aorta or poor quality of saphenous vein graft.