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document
Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients : a prospective randomized evaluation . OBJECTIVES The technique of choice for myocardial revascularization in elderly patients remains a debated issue . We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients . METHODS We prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization . Patients were assigned at random to group 1 , 80 patients undergoing total arterial revascularization ( left internal thoracic artery on left anterior descending coronary artery plus radial artery ) , or group 2 , 80 patients undergoing standard coronary artery bypass graft surgery ( left internal thoracic artery on left anterior descending coronary artery plus saphenous veins ) . The radial artery was used in all cases as a composite Y-graft . RESULTS Preoperative characteristics and risk factors ( EuroSCORE : group 1 = 7.9 vs group 2 = 8.1 ) , number of grafted coronary vessels ( group 1 = 2.4 vs group 2 = 2.5 ) , aortic crossclamping time ( group 1 = 37 +/- 7 minutes vs group 2 = 38 +/- 7 minutes ) , ventilation time ( group 1 = 22 +/- 12 hours vs group 2 = 23 +/- 11 hours ) , intensive care unit stay ( group 1 = 39 +/- 10 hours vs group 2 = 40 +/- 9 hours ) , and hospital mortality ( group 1 = 3.8 % vs group 2 = 5 % ) were comparable between the groups . Comparison between the 2 groups in terms of early postoperative complications showed a higher incidence of cerebrovascular accidents in group 2 ( group 1 = 0 patients vs group 2 = 4 patients , 5 % ) . At a mean follow-up of 16 +/- 3 months , patients in group 1 showed superior clinical results with a lower incidence of graft occlusion ( group 1 = 2 vs group 2 = 11 ; P =.06 ) and angina recurrence ( group 1 = 2 patients vs group 2 = 12 patients ; P =.03 ) . Multivariate analysis identified saphenous vein grafts as independent predictors for graft occlusion and angina recurrence . CONCLUSIONS Left internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients . It improved the clinical outcome , providing a significantly higher graft patency rate and a lower incidence of late cardiac events .
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Intervention_Surgical
Left internal thoracic artery-radial artery composite grafts
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Intervention_Surgical
left internal thoracic artery-radial artery composite grafts
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Intervention_Surgical
conventional coronary artery bypass grafts
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Intervention_Surgical
isolated myocardial revascularization
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Intervention_Surgical
total arterial revascularization ( left internal thoracic artery on left anterior descending coronary artery plus radial artery )
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Intervention_Surgical
standard coronary artery bypass graft surgery ( left internal thoracic artery on left anterior descending coronary artery plus saphenous veins ) .
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Intervention_Surgical
composite Y-graft
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Outcome_Physical
number of grafted coronary vessels
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Outcome_Physical
aortic crossclamping time
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Outcome_Other
ventilation time
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Outcome_Other
intensive care unit stay
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Outcome_Mortality
hospital mortality
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Outcome_Adverse-effects
early postoperative complications
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Outcome_Physical
cerebrovascular accidents
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Outcome_Physical
graft occlusion
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Outcome_Physical
angina recurrence
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Outcome_Physical
graft occlusion
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Outcome_Physical
angina recurrence
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Participant_Condition
myocardial revascularization in elderly patients :
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Participant_Condition
elderly patients